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Xiao Y, Zhang Y, Xie K, Huang X, Liu X, Luo J, Tan S. Mitochondrial Dysfunction by FADDosome Promotes Gastric Mucosal Injury in Portal Hypertensive Gastropathy. Int J Biol Sci 2024; 20:2658-2685. [PMID: 38725851 PMCID: PMC11077381 DOI: 10.7150/ijbs.90835] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Mucosal epithelial death is an essential pathological characteristic of portal hypertensive gastropathy (PHG). FADDosome can regulate mucosal homeostasis by controlling mitochondrial status and cell death. However, it remains ill-defined whether and how the FADDosome is involved in the epithelial death of PHG. The FADDosome formation, mitochondrial dysfunction, glycolysis process and NLRP3 inflammasome activation in PHG from both human sections and mouse models were investigated. NLRP3 wild-type (NLRP3-WT) and NLRP3 knockout (NLRP3-KO) littermate models, critical element inhibitors and cell experiments were utilized. The mechanism underlying FADDosome-regulated mitochondrial dysfunction and epithelial death in PHG was explored. Here, we found that FADD recruited caspase-8 and receptor-interacting serine/threonine-protein kinase 1 (RIPK1) to form the FADDosome to promote Drp1-dependent mitochondrial fission and dysfunction in PHG. Also, FADDosome modulated NOX2 signaling to strengthen Drp1-dependent mitochondrial fission and alter glycolysis as well as enhance mitochondrial reactive oxygen species (mtROS) production. Moreover, due to the dysfunction of electron transport chain (ETC) and alteration of antioxidant enzymes activity, this altered glycolysis also contributed to mtROS production. Subsequently, the enhanced mtROS production induced NLRP3 inflammasome activation to result in the epithelial pyroptosis and mucosal injury in PHG. Thus, the FADDosome-regulated pathways may provide a potential therapeutic target for PHG.
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Affiliation(s)
- Yuelin Xiao
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Yiwang Zhang
- Department of Pathology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Kaiduan Xie
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Xiaoli Huang
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Xianzhi Liu
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Jinni Luo
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
| | - Siwei Tan
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, 510630, China
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Ono R, Goto H, Oyama Y, Tateishi K, Takaoka H, Kato N, Kobayashi Y. Hepatic encephalopathy due to cardiac cirrhosis. Clin Case Rep 2023; 11:e7843. [PMID: 37636886 PMCID: PMC10457474 DOI: 10.1002/ccr3.7843] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Right-sided heart failure, including tricuspid regurgitation (TR), can cause cardiac cirrhosis. The pathophysiology is reduced arterial perfusion and passive congestion secondary to increased systemic venous pressure. However, hepatic encephalopathy due to cardiac cirrhosis is rare. This is the first case of hepatic encephalopathy with cardiac cirrhosis caused by persistent TR.
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Hiroki Goto
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Yuhei Oyama
- Department of GastroenterologyChiba University Graduate School of MedicineChibaJapan
| | - Kazuya Tateishi
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Hiroyuki Takaoka
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Naoya Kato
- Department of GastroenterologyChiba University Graduate School of MedicineChibaJapan
| | - Yoshio Kobayashi
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
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Mehta SK, Sunny S, Nafe Z, Priyadarshi K, Singh PK. Trends of Chronic Liver Disease in a Tertiary Care Centre in the Eastern Part of India: A Retrospective Study. Cureus 2023; 15:e36662. [PMID: 37101985 PMCID: PMC10124149 DOI: 10.7759/cureus.36662] [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] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
AIM OF THE STUDY To assess the relationship between the severity of liver cirrhosis and its outcomes based on laboratory parameters, Child-Turcotte-Pugh (CTP) score, and upper gastrointestinal (UGI) endoscopy findings. BACKGROUND Cirrhosis is the end stage of chronic liver disease (CLD) and is characterised by progressive liver fibrosis and distortion of the liver architecture. It is a major cause of morbidity and mortality all over the world. Cirrhosis is compensated in the initial stages and later progresses to the decompensated stage with various complications. The CTP scoring system predicts mortality in patients with cirrhosis. MATERIALS AND METHODS This retrospective study was done in the Department of Medicine and Gastroenterology of Tata Main Hospital (TMH), Jamshedpur, Jharkhand, India. It was conducted over a period of two years between 1 January 2019 and 31 December 2020, on 150 confirmed cases of cirrhosis. RESULTS The most common age group was 41-60 years (86, 57.33%) and the mean age ± standard deviation (SD) for all patients was 49.82 ± 11.63 years. In a total of 150 CLD cases, males were 96 (64%). The most common cause of CLD was alcohol (76, 50.67%). Based on presenting symptoms, most CLD patients presented with generalized weakness (144, 96.00%). The most common signs were icterus (68, 45.33%) and ascites (44, 29.33%). Most patients belonged to CTP class A (77, 51.33%), followed by CTP class B (44, 29.33%) and class C (29, 19.34%). The most common UGI endoscopy finding was portal hypertensive gastropathy (mild or severe) (135, 75%). Total deaths were 24 (16.00%), with 17 deaths (70.83%) in patients belonging to CTP class C. CONCLUSION CLD is a common entity in eastern India with male preponderance and affects mostly people of the middle age group. Alcohol intake is a major cause of CLD, followed by non-alcoholic fatty liver disease and chronic hepatitis B and C. A significant rise in morbidity and mortality due to alcoholic liver disease (ALD) was observed in the study and needs urgent social and medical intervention. The incidence of ALD in our study was 50.67%.
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Affiliation(s)
- Sameer K Mehta
- Department of General Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Shashank Sunny
- Department of Internal Medicine, Tata Main Hospital, Jamshedpur, IND
| | - Zaid Nafe
- Department of Community Medicine, Tata Main Hospital, Jamshedpur, IND
- Department of Community Medicine, Dr. Vaishampayan Memorial Government Medical College, Solapur, IND
| | | | - Prashant K Singh
- Department of Critical Care Medicine, Tata Main Hospital, Jamshedpur, IND
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Nishino K, Kawanaka M, Manabe N, Suehiro M, Kawamoto H, Haruma K. Portal Hypertensive Gastropathy in Liver Cirrhosis: Prevalence, Natural History, and Risk Factors. Intern Med 2022; 61:605-613. [PMID: 35228473 PMCID: PMC8943373 DOI: 10.2169/internalmedicine.7943-21] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Portal hypertensive gastropathy (PHG) is a common finding in patients with liver cirrhosis (LC) and may cause both acute and chronic bleeding. A number of risk factors for PHG have been identified. The present study explored the characteristics of Japanese patients with LC who develop PHG. Methods Clinical findings (age, sex, etiology, the presence of esophageal varices, splenomegaly and severity of LC), laboratory data, and whether or not atrophic gastritis was found on endoscopy were retrospectively reviewed in patients with LC who had undergone esophagogastroduodenoscopy. PHG was endoscopically graded as absent, mild, or severe. Results Of 262 patients with LC (mean age, 69 years old; 145 men), 158 had no PHG, 41 had mild PHG, and 63 had severe PHG. In a univariate analysis, a younger age, male sex, non-viral etiology, absence of atrophic gastritis, presence of esophageal varices, splenomegaly, severe LC, low platelet count, and low hemoglobin concentration were associated with PHG. A multivariate analysis showed a significant association of PHG with the absence of atrophic gastritis (p<0.048), presence of esophageal varices (p<0.001), non-viral etiology (p<0.033), splenomegaly (p<0.048), and severe LC (p<0.005). There were no cases of massive bleeding from PHG during follow-up. Conclusion Esophageal varices, splenomegaly, severe liver cirrhosis, the absence of atrophic gastritis, and etiology were found to be risk factors for PHG in Japanese patients.
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Affiliation(s)
- Ken Nishino
- General Medical Center, Kawasaki Medical School, Department of General Internal Medicine 2, Japan
| | - Miwa Kawanaka
- General Medical Center, Kawasaki Medical School, Department of General Internal Medicine 2, Japan
| | - Noriaki Manabe
- General Medical Center, Kawasaki Medical School, Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine, Japan
| | - Mitsuhiko Suehiro
- General Medical Center, Kawasaki Medical School, Department of General Internal Medicine 2, Japan
| | - Hirofumi Kawamoto
- General Medical Center, Kawasaki Medical School, Department of General Internal Medicine 2, Japan
| | - Ken Haruma
- General Medical Center, Kawasaki Medical School, Department of General Internal Medicine 2, Japan
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Furuichi Y, Koyama Y, Abe M, Yoshimasu Y, Takeuchi H, Itoi T. Discrimination between Portal Hypertensive Gastropathy and Helicobacter pylori-related Gastritis. Intern Med 2022; 61:601-603. [PMID: 35228472 PMCID: PMC8943375 DOI: 10.2169/internalmedicine.8228-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yoshihiro Furuichi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Japan
| | - Yohei Koyama
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
- Department of Gastroenterology, Niiza Shiki Central General Hospital, Japan
| | - Masakazu Abe
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Yuu Yoshimasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
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Amer IF, El Shennawy EM, El Batea H, Ahmed MH, El Sharawy S, Mahros AM. Accuracy of noninvasive tests in the prediction of portal hypertensive gastropathy in Egyptian patients with cirrhosis. JGH Open 2021; 5:286-293. [PMID: 33553669 PMCID: PMC7857295 DOI: 10.1002/jgh3.12486] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/23/2022]
Abstract
Background and Aim Liver cirrhosis (LC) is commonly associated with portal hypertensive gastropathy (PHG), and it causes gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard in diagnosing PHG. Besides its invasiveness, the disadvantages of EGD include psychological and financial problems. We aimed to evaluate the diagnostic accuracy of different noninvasive screening tools in predicting PHG. Methods This cross‐sectional study was conducted on 100 patients with LC who were divided into two groups based on EGD: group (A), 50 patients with LC with PHG, and group (B), 50 patients with LC without PHG. All patients were subjected to history taking, full clinical examination, laboratory investigations, abdominal–pelvic ultrasonography, and EGD. Results To predict PHG, the respective sensitivity and specificity of portal vein diameter (>10.5 mm) were 86 and 67%, of gallbladder wall thickness (GBWT) (>3.5 mm) were 64 and 68%, of platelets/GBWT (<40) were 68 and 78%, of aspartate aminotransferase (AST)/platelet ratio index (APRI) score (>1.1) were 60 and 66%, of platelet/spleen diameter (<1290) were 88 and 72%, of right liver lobe diameter/albumin ratio (>4) were 74 and 80%, and of AST/alanine aminotransferase (ALT) ratio (>1.1) were 50 and 58% (P = 0.353). Conclusion Portal vein diameter, platelet/spleen diameter, and right liver lobe diameter/albumin ratio were independently associated with PHG and were good predictors of the PHG, whereas AST/ALT ratio and King score are poor predictors.
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Affiliation(s)
- Ibrahim F Amer
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Eslam M El Shennawy
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Hassan El Batea
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Mohammed Hussien Ahmed
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
| | - Shimaa El Sharawy
- Tropical Medicine Department, Faculty of Medicine Tanta University Tanta Egypt
| | - Aya M Mahros
- Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine Kafrelsheikh University Kafr el-Sheikh Egypt
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Tiwari PS, Kc S, Sharma D, Paudel MS, Mandal A. Prevalence of Portal Hypertensive Gastropathy in Chronic Liver Disease and Correlation with the Severity of Liver disease. Cureus 2019; 11:e5454. [PMID: 31641555 PMCID: PMC6802813 DOI: 10.7759/cureus.5454] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Portal hypertensive gastropathy (PHG) is an underappreciated condition in patients with chronic liver disease (CLD). It is a common endoscopic finding in CLD patients, but its relation with esophageal varices (EV) and the severity of the liver disease is controversial. Herein, we aimed to study the prevalence of PHG in CLD patients and to determine its association with EV and the severity of the liver disease. Methods This descriptive, cross-sectional, analytical study was conducted at the Hepatology department, Bir Hospital Kathmandu from 19th March to 30th June 2019. A total of 404 patients with CLD of various etiology fulfilling the inclusion criteria were approached, and informed consent was taken before enrolling in the study. All patients underwent EGD, and the findings related to EV and PHG were noted. The severity of PHG was graded according to the McCormack classification and EV were graded according to the American Association for the study of liver diseases guideline. The severity of liver disease was stratified based on Child-Pugh class and Model for End-Stage Liver Disease (MELD score). Data was entered on Statistical Package for the Social Sciences (SPSS) Version 25 for further analysis. Results Of 404 CLD patients, the mean (±SD) age was 49.14 (±10.5) years. Portal hypertensive gastropathy was observed in 269 (66.6%) patients, of which 80.6% (217) had mild PHG while 19.4% (52) had severe PHG. EV were present in 362 (89.6%) patients. One hundred and thirty-two (36.5%) had small EV, and 230 (63.5%) had large EV. No significant association was observed between grades of gastropathy and size of varices (p = 0.36). There was a non-significant association with the MELD score and other biochemical parameters. However, there were significant associations between Child-Pugh class and PHG and Child-Pugh class and PHG severity, p = 0.001 and p = 0.01 (p <0.05), respectively. Conclusions In our study, the prevalence of PHG in the Nepalese population in CLD is 66.6 %. PHG is significantly associated with the severity of CLD in terms of Child-Pugh class but not associated with MELD. Also, no association has been found with the size of varices.
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Affiliation(s)
- Pratap S Tiwari
- Hepatology, National Academy of Medical Sciences, Kathmandu, NPL
| | - Sudhamshu Kc
- Hepatology, National Academy of Medical Sciences, Kathmandu, NPL
| | - Dilip Sharma
- Hepatology, National Academy of Medical Sciences, Kathmandu, NPL
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Hakim S, Bortman J, Orosey M, Cappell MS. Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding: Left gastric artery pseudoaneurysm compressing the splenic vein treated by embolization of the pseudoaneurysm. Medicine (Baltimore) 2017; 96:e6413. [PMID: 28353569 PMCID: PMC5380253 DOI: 10.1097/md.0000000000006413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization. CASE REPORT A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up. DISCUSSION Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA. CONCLUSION A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not the secondarily constricted SV.
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Affiliation(s)
- Seifeldin Hakim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital
| | - Jared Bortman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Molly Orosey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital
| | - Mitchell S. Cappell
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, William Beaumont Hospital
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Abstract
Portal hypertensive gastropathy (PHG) is a painless condition of gastric mucosal ectasia and impaired mucosal defense, commonly seen in patients with elevated portal pressures. While it is typically asymptomatic and incidentally discovered on upper endoscopy, acute and chronic bleeding may occur. There are no definitive recommendations for treatment of asymptomatic PHG. Non-selective β-blockers represent the mainstay of therapy for chronic bleeding, while somatostatin and vasopressin and their derivatives may be used in conjunction with supportive measures for acute bleeding. Salvage therapy with transjugular intrahepatic portosystemic shunt or rarely surgical shunt is appropriate when medical management fails. The role of endoscopic therapy for PHG is controversial. Liver transplantation should be considered as a final resort in cases of refractory bleeding due to PHG.
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Affiliation(s)
- Patrick Snyder
- a 1 New York University Medical School, 550 1st Avenue, New York, NY 10016, USA
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Kobryn K, Kozieł S, Patkowski W, Grąt M, Wróblewski T, Krawczyk M. Intraoperative salvage endoscopy performed during orthotopic liver transplantation due to esophageal bleeding. Wideochir Inne Tech Maloinwazyjne 2015; 10:472-6. [PMID: 26649098 DOI: 10.5114/wiitm.2015.54559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/28/2015] [Accepted: 09/17/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Liver transplantation (LTx) is a widely accepted method of treatment for end stage liver diseases. There are many reports on the management of gastrointestinal bleeding (GIB) after LTx, however the number of studies concerning salvage endoscopic procedures during LTx are scarce. Aim We present our material of intraoperative endoscopic procedures due to GIB during LTx. Material and methods During this period there were 4 females and 1 male at the mean age of 52.2 (35–65) years who underwent LTx and 1 patient had Re-LTx. All patients were Child-Pugh group C and mean MELD score was 17.75. Esophageal and/or gastric varices were present before surgery in all patients but only 1 female patient didn't experience GIB prior to LTx. Variables such as operating time, cold ischemic time, blood loss, blood transfusion, PLT count, international normalized ratio, albumin levels were similar in all patients thus making it statistically insignificant as the cause of GIB. Results In all cases a single IOE was necessary and bleeding from ruptured varices succumbed to endoscopic ligation. In 2 patients besides trials of ligating the varix, histoacryl was put in use which proved success. In both these last female patients the endoscopic physician had to insert a Danis stent. A follow up endoscopy was performed on the 7–10 POD. Conclusions Intra-operative endoscopy performed during LTx does not interrupt surgery. Performed as soon as possible results in less future endoscopic interventions due to GIB. Intraoperative endoscopy may be considered as a salvage procedure and should be performed in the shortest possible time.
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Aoyama T, Oka S, Aikata H, Nakano M, Watari I, Naeshiro N, Yoshida S, Tanaka S, Chayama K. Is small-bowel capsule endoscopy effective for diagnosis of esophagogastric lesions related to portal hypertension? J Gastroenterol Hepatol 2014; 29:511-6. [PMID: 23981241 DOI: 10.1111/jgh.12372] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Effectiveness of capsule endoscopy (CE) for screening the small bowel in patients with portal hypertension (PHT) has been reported. However, few reports discuss CE detection of specific esophagogastric lesions related to PHT. Thus, we assessed whether CE is useful for detecting such lesions. METHODS One hundred nineteen consecutive patients with PHT comprised the study group. All had undergone esophagogastroduodenoscopy (EGD) prior to CE. The diagnostic yield of CE for esophageal varices (EVs), gastric varices (GVs), and portal hypertensive gastropathy (PHG) was evaluated. In addition, diagnostic yield in relation to form, location of the varices, grade, and extent of PHG was evaluated. RESULTS EVs were found by EGD in 71 patients. The overall diagnostic yield of CE for EVs was 72% (51/71). The diagnostic yield was significantly greater for F2/F3 EVs than for F1 EVs (87% vs 61%, P = 0.03). The diagnostic yield was significantly greater for Lm/Ls EVs than for Li EVs (85% vs 55%, P = 0.01). The diagnostic yield was significantly greater for locus superior/locus medialis EVs than for locus inferior EVs (85% vs 55%, P = 0.01). GVs were found by EGD in 29 patients. Only one case was detected by CE. PHG was found by EGD in 35 patients. The diagnostic yield of CE for PHG was 69% (24/35). There was no difference in diagnostic yield between cases of severe and mild PHG (82% vs 63%, P = 0.44). Diagnostic yield of CE for PHG in the gastric body was significantly greater than that in the fundus (100% vs 48%, P = 0.0009). CONCLUSION CE is reliable for diagnosis of F2/F3 and/or Lm/Ls EVs and of PHG in the gastric body.
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Affiliation(s)
- Taiki Aoyama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
Portal hypertensive gastropathy and gastric antral vascular ectasia may cause gastrointestinal hemorrhage in patients with portal hypertension. Whereas the former presents exclusively in patients with portal hypertension, gastric antral vascular ectasia can also be observed in patients with other conditions. Diagnosis is established with upper gastrointestinal endoscopy, although some cases may require a biopsy to confirm the diagnosis. The most frequent manifestation is ferropenic anemia, which may become transfusion dependent. Treatment in portal hypertensive gastropathy is focused on portal pressure reducing drugs, mainly nonselective beta-blockers, whereas in gastric antral vascular ectasia treatment is based on endoscopic ablation. More invasive options can be used if first-line therapies fail, although these should be evaluated on a case-by-case basis.
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Affiliation(s)
| | - Guadalupe Garcia-Tsao
- Corresponding author: Guadalupe Garcia-Tsao, M.D., Digestive Diseases Section, Yale University School of Medicine, 333 Cedar Street – 1080 LMP, New Haven, CT 06510, , Tph: 203 737 6063, Fax: 203 785-7273
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Rafailidis S, Demertzidis C, Ballas K, Alatsakis M, Symeonidis N, Pavlidis T, Psarras K, Tzioufa-Asimakopoulou V, Sakadamis A. Effect of early propranolol administration on portal hypertensive gastropathy in cirrhotic rats. World J Gastroenterol 2009; 15:4284-9. [PMID: 19750571 PMCID: PMC2744184 DOI: 10.3748/wjg.15.4284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 05/28/2009] [Revised: 08/12/2009] [Accepted: 08/19/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate any protective effect of early propranolol administration in the development of portal hypertensive gastropathy in cirrhotic rats. METHODS For the development of liver cirrhosis and portal hypertensive gastropathy, 60 rats underwent ligation of the left adrenal vein and complete devascularization of the left renal vein, followed by phenobarbital and carbon tetrachloride (CCl(4)) administration. After two weeks of CCl(4) administration, the rats were randomly separated into two groups. In group A, propranolol was continuously administered intragastrically throughout the study, whereas in group B normal saline (placebo) was administered instead. Hemodynamic studies and vascular morphometric analysis of gastric sections were performed after complete induction of cirrhosis. RESULTS Vascular morphometric studies showed higher numbers of vessels in all mucosal layers in the control group. Statistical analysis revealed a significantly higher total vascular surface in the control group compared to the propranolol group, but with no statistically significant difference between the mean vascular surfaces between the groups. Our study clearly shows that the increased mucosal blood flow is manifested by a marked increase of vessel count. CONCLUSION Early propranolol's administration in portal hypertensive cirrhotic rats seems to prevent intense gastric vascular congestion that characterizes portal hypertensive gastropathy.
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