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1.
In Seok Lee Suck Chei Choi Ki Nam Shim Sam Ryong Jee Kyu Chan Huh Jun Haeng Lee Kwang Jae Lee Hyung Seok Park Yong Chan Lee Hoon Yong Jung Hyo Jin Park 《Digestive diseases and sciences》2010,55(7):1932-1939
Purpose
In contrast to the Western population, the prevalence of Barrett’s esophagus (BE) is rare in the Korean population. However, the recent increase in prevalence of gastroesophageal reflux disease (GERD) may affect the prevalence of BE. The aim of this study was to survey the prevalence of BE and evaluate its risk factors.Methods
Patients between 18 and 75 years of age who visited 11 Korean tertiary referral centers between April and July 2006 for routine upper endoscopic examination were surveyed using a symptom questionnaire. Biopsies were performed on the columnar lined epithelium (CLE) of the distal esophagus, and diagnosis was confirmed with detection of specialized intestinal metaplasia.Results
The study comprised 2,048 patients (mean age 51.4 years, 965 males). The frequency of heartburn or acid regurgitation was 8.7% and 13.1%, respectively. Reflux esophagitis was diagnosed in 10.1% of patients (207 patients); however, most patients had mild reflux. CLE was found in 82 patients; however, only one patient had long-segment CLE. The prevalence of BE was 1% (21 patients). The risk factors for BE were age (P = 0.006), presence of heartburn [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.66–11.34, P = 0.007], acid regurgitation (OR 3.37, 95% CI 1.35–8.42, P = 0.01), sliding hernia (OR 6.21, 95% CI 1.78–21.72, P = 0.001), and reflux esophagitis (OR 10.28, 95% CI 4.31–24.50, P < 0.0001) on univariate analysis. On multivariate analysis, presence of typical reflux symptoms (P = 0.02) and reflux esophagitis (P < 0.001) were significant.Conclusions
Prevalence of Barrett’s esophagus remains low in Koreans; however, risk of developing BE has increased in patients with GERD symptoms and reflux esophagitis. 相似文献2.
Hung HH Su CW Lai CR Chau GY Chan CC Huang YH Huo TI Lee PC Kao WY Lee SD Wu JC 《Hepatology International》2010,4(4):691-699
Purpose
Although advanced liver fibrosis is crucial in the development of hepatocellular carcinoma (HCC) for patients with chronic hepatitis B, whether it is associated with the recurrence of HCC after resection remains obscure. This study was aimed to compare the outcomes for patients with minimal or advanced fibrosis in solitary small hepatitis B virus (HBV)-related HCC.Methods
This study enrolled 76 patients with small (<5 cm) solitary HBV-related HCC who underwent resection. The outcomes of patients with minimal and advanced fibrosis in non-tumor areas were compared. Serum markers were tested to assess the stage of hepatic fibrosis and to predict prognosis.Results
Fourteen patients with an Ishak fibrosis score of 0 or 1 were defined as having minimal fibrosis; the remaining 62 patients were defined as having advanced fibrosis. During a follow-up period of 77.0 ± 50.7 months, 41 patients died. The overall survival rate was significantly higher (P = 0.018) and recurrence rate was lower (P = 0.018) for patients in the minimal fibrosis group. Aspartate aminotransferase–platelet ratio index (APRI) exhibited the most reliable discriminative ability for predicting advanced fibrosis. The overall survival rate was significantly higher (P = 0.003) and recurrence rate was lower (P = 0.005) for patients with an APRI of 0.47 or less.Conclusions
For patients with solitary small HBV-related HCC who underwent resection, minimal fibrosis is associated with a lower incidence of recurrence and with better survival. APRI could serve as a reliable marker for assessing hepatic fibrosis and predicting survival. 相似文献3.
Chung GE Kim W Lee KL Hwang SY Lee JH Kim HY Jung YJ Kim D Jeong JB Kim BG Kim YJ Yoon JH Lee HS 《Digestive diseases and sciences》2011,56(7):2130-2136
Background/Aims
Lamivudine (LAM) has been extensively used to treat hepatitis B, but high incidence of drug resistance has required rescue studies. We validated the optimum treatment strategy for LAM-resistant patients by means of a comparative study of add-on adefovir (ADV) and a switch to entecavir (ETV).Methods
We assessed the virologic response in consecutive LAM-resistant patients who received add-on ADV or a switch to ETV.Results
The mean reduction of serum hepatitis B virus (HBV) DNA levels was significantly less in the ETV group than in the add-on ADV group (?3.45 vs. ?4.17; P = 0.047 at week 24 and ?3.81 vs. ?4.68 log10 IU/mL; P = 0.044 at week 48). Achievement of undetectable HBV DNA was significantly lower in the ETV group than in the add-on ADV group (P = 0.043). Multivariate analysis showed that add-on ADV, baseline HBV DNA levels, and initial virologic response were significant predictors of HBV DNA negativity (adjusted OR, 2.582; P = 0.008, 0.304; P = 0.001, and 5.928; P = 0.001). Virologic breakthrough was observed for 12 patients, in the ETV group only.Conclusions
Add-on ADV was more effective and durable than ETV as rescue therapy. Therefore, add-on ADV might be the preferred strategy for LAM-resistant patients who need long-term antiviral treatment. 相似文献4.
Hassan Ashktorab Omid Entezari Mehdi Nouraie Ehsan Dowlati Wayne Frederick Alfreda Woods Edward Lee Hassan Brim Duane T. Smoot Firoozeh Ghadyari Farin Kamangar Hadie Razjouyan 《Digestive diseases and sciences》2012,57(11):2924-2928
Background and Aim
Negative association has been reported between presence of Helicobacter pylori and developing gastroesophageal reflux disease (GERD) and its complications. The aim of this study was to determine whether H. pylori (HP) can be protective against GERD in an African American (AA) population.Methods
From 2004 to 2007, we studied 2,020 cases; esophagitis (58), gastritis (1,558), both esophagitis and gastritis (363) and a normal control group (41). We collected their pathology and endoscopy unit reports. HP status was determined based on staining of gastric biopsy.Results
HP data was available for 79 % (1,611) of the cases. The frequency of HP positivity in gastritis patients was 40 % (506), in esophagitis patients 4 % and in normal controls 34 % (11), while HP was positive in 34 % of the patients with both esophagitis and gastritis. After adjusting for effects of age and sex, odds ratio of HP was 0.06 (95 % CI 0.01–0.59; P value = 0.01) for the esophagitis group versus the normal group.Conclusions
Our results show H. pylori has a significant negative association with esophagitis in AAs which may point to a protective role of H. pylori in the pathogenesis of esophagitis. In addition, H. pylori may be the reason for the low GERD complications in AAs. 相似文献5.
Zhang TC Pan FM Zhang LZ Gao YF Zhang ZH Gao J Ge R Mei Y Shen BB Duan ZH Li X 《Infection》2011,39(1):21-27
Background
Up to now, many publications about the Chinese population have evaluated the correlation between interleukin-10 (IL-10) ?1082 and ?592 polymorphisms and persistent hepatitis B virus (HBV) infection. However, the results remain inconclusive. In order to resolve this conflict, a meta-analysis was performed.Methods
Seven studies were included and dichotomous data are presented as the odds ratio (OR) with a 95% confidence interval (CI).Results
The results of our study suggest that carriers of the IL-10 ?592A allele were more likely to clear HBV spontaneously in the Chinese pooled population (A vs. C: OR = 0.799, 95% CI = 0.678–0.941, P = 0.007; AC vs. AA: OR = 1.343, 95% CI = 1.017–1.684, P = 0.011; AA vs. AC + CC: OR = 0.736, 95% CI = 0.594–0.912; AA + AC vs. CC: OR = 0.588, 95% CI = 0.408–0.848, P = 0.004) and the IL-10 ?1082A allele was associated with significantly reduced persistent HBV infection risk in Chinese (A vs. G: OR = 0.701, 95% CI = 0.494–0.996, P = 0.047; AA vs. GG + GA: OR = 0.684, 95% CI = 0.476–0.982, P = 0.040).Conclusions
Persistent HBV infection susceptibility is associated with the gene polymorphism IL-10 ?1082GA in the Chinese population and the clearance of HBV is associated with the gene polymorphism IL-10 ?592CA in the Chinese population. 相似文献6.
Man-Man Wang Gong-Sui Wang Feng Shen Guang-Yu Chen Qin Pan Jian-Gao Fan 《Digestive diseases and sciences》2014,59(10):2571-2579
Background and Aims
The interaction between hepatitis B virus (HBV) infection and hepatic steatosis remains unclear. We aimed to explore the trend of prevalence of hepatic steatosis and its relationship with virological factors in HBV infected patients.Methods
Consecutive untreated patients with chronic HBV infection at Shunde Hospital between 2002 and 2011 were included. Quantification of HBV replication markers was performed by enzyme immunoassay, real-time polymerase chain reaction assay and immunohistochemical staining. Hepatic steatosis was defined as at least 5 % hepatocytes affected.Results
A total of 3,212 patients (2,574 men) with a mean age of 32 ± 9.3 years were analyzed. Serological testing showed detectable HBsAg in all, HBeAg in 63.8 % and HBV DNA in 78.4 % of patients. Liver biopsies demonstrated HBsAg- and HBcAg-positive immunostaining in 96.6 and 71 % patients, respectively. Hepatic steatosis was present in 554 (17.3 %) patients, with annual prevalence increased over time from 8.2 to 31.8 % (trend analysis, x 2 = 51.657, P < 0.001). Compared to patients without steatosis, the percentages of serum HBeAg-positive and detectable HBV DNA, and intrahepatic HBsAg- and HBcAg-positive staining were decreased in steatosis patients (all P < 0.001). Adjusted for age and gender, intrahepatic HBsAg-positive staining remained as an independent factor associated with lower risk of steatosis (adjusted odds ratio 0.90, 95 % confidence interval 0.835, 0.971) in multivariate analysis.Conclusions
Hepatic steatosis in HBV infected patients has been raging over the past decade, and it is negatively associated with intrahepatic expression of HBsAg. Lifestyle intervention may be needed to halt the onset of steatosis in chronic HBV infection. 相似文献7.
Yasuhiro Fujiwara Tetsuya Tanigawa Hirokazu Yamagami Kenji Watanabe Kazunari Tominaga Toshio Watanabe Tetsuo Arakawa 《Esophagus》2013,10(4):199-204
Background
Eosinophilic esophagitis (EoE) is diagnosed on the basis of the presence of dysphagia and intraepithelial eosinophilic infiltration of ≥15 cells per high-power field; nevertheless, it is important to identify the endoscopic findings of EoE in general practice. EoE should be distinguished from gastroesophageal reflux disease (GERD); however, the associations between EoE and GERD are controversial. Herein, we aimed to determine the prevalence of EoE-like endoscopic findings and associations between an EoE-like endoscopic appearance and erosive esophagitis.Methods
Prospective endoscopic examination was performed in 804 consecutive cases. Cases with EoE-like endoscopic findings such as furrows, rings, white exudate, stricture, and mucosal tearing were examined by esophageal biopsy. Erosive esophagitis, hiatal hernia, atrophic gastritis, and gastroesophageal flap valve were assessed endoscopically, and clinical data, including age, gender, smoking and drinking habits, and presence of allergic diseases and symptoms such as dysphagia and heartburn, were analyzed.Results
Of the 804 cases, 36 (4.5 %) showed an EoE-like endoscopic appearance, and 80 (10 %) had erosive esophagitis. Among the 36 cases with an EoE-like appearance, only 4 (0.5 %) showed significant esophageal eosinophilic infiltration with erosive esophagitis in 3 cases. Further, 28 % of the patients with erosive esophagitis had an EoE-like endoscopic appearance, while 61 % of those with an EoE-like endoscopic appearance had erosive esophagitis. There were no significant differences between the clinical characteristics and other endoscopic findings in cases of an EoE-like endoscopic appearance and erosive esophagitis.Conclusion
Erosive esophagitis and an EoE-like endoscopic appearance frequently showed overlapping features; thus, we believe they might have common pathogenic factors. 相似文献8.
Masataka Tsuge Eisuke Murakami Michio Imamura Hiromi Abe Daiki Miki Nobuhiko Hiraga Shoichi Takahashi Hidenori Ochi C. Nelson Hayes Hiroyuki Ginba Kazuhiro Matsuyama Hiroiku Kawakami Kazuaki Chayama 《Journal of gastroenterology》2013,48(10):1188-1204
Background
Treatment for chronic hepatitis B has improved drastically with the use of nucleot(s)ide analogues (NAs). However, NA therapy typically fails to eliminate Hepatitis B virus (HBV) completely, and it is difficult to discontinue these therapies. We previously demonstrated that NA therapy induced immature viral particles, including HBV RNA in sera of chronic hepatitis B patients. In the study reported here, we analyzed the association between HBV RNA titer and the recurrence rate of hepatitis after discontinuation of NA therapy.Methods
The study cohort comprised 36 patients who had discontinued NA therapy. Serum HBV DNA or DNA plus RNA levels were measured by real time PCR and statistical analyses were performed using clinical data and HBV markers.Results
At 24 weeks after discontinuation of NA therapy, HBV DNA rebound was observed in 19 of the 36 patients (52.8 %), and alanine aminotransferase (ALT) rebound was observed in 12 of 36 patients (33.3 %). Multivariate statistical analysis was used to identify factors predictive of HBV DNA rebound. The HBV DNA + RNA titer following 3 months of treatment was significantly associated with HBV DNA rebound [P = 0.043, odds ratio (OR) 9.474, 95 % confidence interval (CI) 1.069–83.957)]. Absence of hepatitis B e antigen (HBeAg) at the end of treatment was significantly associated with ALT rebound (P = 0.003, OR 13.500, 95 % CI 2.473–73.705). In HBeAg-positive patients, the HBV DNA + RNA titer after 3 months of treatment was marginally associated with ALT rebound (P = 0.050, OR 8.032, 95 % CI 0.997–64.683).Conclusions
Monitoring of serum HBV DNA + RNA levels may be a useful method for predicting re-activation of chronic hepatitis B after discontinuation of NA therapy. 相似文献9.
Nobuyuki Matsuki Tsuyoshi Fujita Naoya Watanabe Atsushi Sugahara Akihiko Watanabe Tsukasa Ishida Yoshinori Morita Masaru Yoshida Hiromu Kutsumi Takanobu Hayakumo Hidekazu Mukai Takeshi Azuma 《Journal of gastroenterology》2013,48(3):340-349
Background
We aimed to clarify the lifestyle factors associated with erosive esophagitis and non-erosive reflux disease (NERD) in a Japanese population.Methods
Among 886 subjects who underwent health screening, we selected, according to their scores on the FSSG (frequency scale for symptoms of gastroesophageal reflux disease; GERD) questionnaire and the findings of upper gastrointestinal endoscopy, 138 subjects with erosive esophagitis (EE), 148 subjects with NERD (absence of esophagitis, FSSG score ≥8, and acid reflux-related symptoms score ≥4), and 565 control subjects (absence of esophagitis and FSSG score ≤7). We compared clinical characteristics and various lifestyle factors in these three groups.Results
The lifestyle factors significantly associated with NERD compared with findings in the control group were intake of egg (odds ratio [OR] 1.89, 95 % confidence interval [CI] 1.01–3.50), sleep shortage (OR 2.44, 95 % CI 1.54–3.88), and strong psychological stress (OR 1.77, 95 % CI 1.18–2.62). In male subjects, current smoking (OR 2.06, 95 % CI 1.13–3.74; OR 1.87, 95 % CI 1.09–3.20) was a significant risk factor for both NERD and EE. Moreover, alcohol >200 kcal/day (OR 3.99, 95 % CI 1.03–15.55) and intake of a large quantity of food at supper (OR 7.85, 95 % CI 1.66–37.05) were significant risk factors for EE in subjects with hiatal hernia. Intake of a large quantity of food at supper (OR 2.09, 95 % CI 1.06–4.13) was more common in the NERD group than in the EE group.Conclusions
There were differences in the associated lifestyle factors between patients with NERD and those with EE, and there was also a gender-related difference between these groups. 相似文献10.
Jia-Feng Wu Wen-Yu Tsai Yi-Ching Tung Huey-Ling Chen Yen-Hsuan Ni Hong-Yuan Hsu Mei-Hwei Chang 《Journal of gastroenterology》2014,49(5):900-906
Background
The natural course of chronic hepatitis B virus (HBV) infection and relevant host factors remain unclear. This study aims to investigate the impact of dehydroepiandrosterone sulfate (DHEAS) on the clearance of chronic HBV infection.Methods
Two hundred and one hepatitis B e antigen (HBeAg)-positive chronic HBV-infected children (101 females) were recruited. Serum DHEAS levels were determined in all subjects at 15 years of age. Serum alanine aminotransferase (ALT) levels, DHEAS levels, HBV seromarkers, genotypes, and viral loads were included for analysis.Results
Subjects with serum DHEAS levels >3.6 μmol/L at midpuberty had earlier HBeAg seroconversion (median age, 14.7 vs. 18.2 years; HR, 1.9; P = 0.03), and the impact persisted even after adjusting for gender, HBV genotype, peak ALT levels, and viral load. Subjects with DHEAS levels >3.6 μmol/L at 15 years of age had more HBV viral titers decrement from 15 to 20 years of age (mean ± SD, 3.5 ± 2.5 vs. 1.2 ± 2.2 log10 copies/mL; P = 0.05) and shorter duration for HBeAg seroconversion than others (mean ± SD, 5.6 ± 4.4 vs. 9.2 ± 4.9 years; P = 0.02). Higher serum DHEAS levels at 15 years of age are also associated with greater hepatitis B surface antigen (HBsAg) titer decrement from 15 to 20 years of age (correlation coefficient = 0.45, P = 0.04).Conclusions
Higher serum DHEAS levels at midpuberty predicts more HBV viral load and HBsAg titer decrement from midpuberty to young adulthood. Higher serum DHEAS levels at midpuberty also correlate with younger age of spontaneous HBeAg seroconversion in chronic genotype B and C HBV-infected patients. 相似文献11.
Chang Mo Moon Seok-Hyung Kim Sang Kil Lee Jiyeon Hyeon Ja Seung Koo Sangheun Lee Jean S. Wang Won Jae Huh Shradha S. Khurana Jason C. Mills 《Digestive diseases and sciences》2014,59(6):1244-1254
Background
Intestinal metaplasia (IM), a premalignant lesion, is associated with an increased risk of gastric cancer. Although estrogen exposure, including tamoxifen, has been studied in correlation with gastric cancer, little has been investigated about its effects on IM.Aims
Therefore, we investigated whether chronic tamoxifen use was associated with the risk of IM in human stomach.Methods
We evaluated 512 gastric biopsies from 433 female breast cancer patients that underwent endoscopic gastroduodenoscopy (EGD) ≥6 months after breast surgery. Histopathological findings were scored according to the updated Sydney classification. Demographic and clinical characteristics were also included to identify predictive factors for IM.Results
In a multivariate logistic regression analysis, age at EGD (odds ratio [OR], 1.04; P = 0.002), biopsies from antrum (OR 2.08; P < 0.001), and Helicobacter pylori positivity (OR 1.68; P = 0.016) were significantly associated with an increased risk of IM, whereas chronic tamoxifen use (≥3 months) was associated with a decreased risk of IM (OR 0.59; P = 0.025). After stratifying by biopsy site, association between tamoxifen use and IM persisted for corpus (OR 0.42; P = 0.026) but not for antrum (OR 0.74; P = 0.327). In analysis limited to patients with follow-up EGD, chronic tamoxifen use also correlated with improved IM score compared to no tamoxifen use (improved, 77.8 vs. 22.2 %; no change, 65.4 vs. 34.6 %; worsened, 30.0 vs. 70.0 %; P = 0.019).Conclusions
This study suggests that chronic tamoxifen use can decrease the risk of IM in human stomach. The effect of tamoxifen is predominantly observed in the corpus. 相似文献12.
Yoshikazu Kinoshita Hiroto Miwa Katsuyuki Sanada Koji Miyata Ken Haruma 《Journal of gastroenterology》2014,49(4):628-637
Background
Patients with gastroesophageal reflux disease (GERD) frequently have symptoms of dyspepsia in addition to reflux symptoms. Treatment options for dyspepsia are not standardized. The aim of this study was to clarify the therapeutic effect of lansoprazole on dyspepsia in Japanese patients with GERD.Methods
GERD patients with dyspepsia were enrolled and treated with lansoprazole 15 or 30 mg once daily for 4 weeks. Reflux and dyspeptic symptoms were assessed by questionnaires before treatment, and 2 and 4 weeks after the start of lansoprazole treatment.Results
In the effectiveness analysis set (n = 12,653), heartburn was reported by 91.6 % of patients at study enrollment. Postprandial fullness was the most frequently reported dyspepsia symptom at the start of the study, reported by 79.0 % of enrolled patients. After 4 weeks of lansoprazole treatment, heartburn symptoms were improved in 75.7 % of patients and symptoms of postprandial fullness were improved in 68.7 % of patients. The therapeutic effect of low and high doses of lansoprazole on dyspepsia, as well as on reflux symptoms, was approximately 10 % higher in patients with endoscopy-confirmed erosive esophagitis (60.1–82.2 %), than in patients with non-erosive reflux diseases (53.0–73.3 %). Lansoprazole was well tolerated.Conclusion
In this large-scale clinical study, lansoprazole effectively relieved dyspepsia in addition to reflux symptoms in patients with GERD. 相似文献13.
Arifumi Iwata Kei Ikeda Koichi Hirose Hiroaki Takatori Kentaro Takahashi Yoshie Sanayama Shigeru Tanaka Akira Suto Hiroshi Nakajima 《Modern rheumatology / the Japan Rheumatism Association》2013,23(2):357-364
Background
A significant proportion of patients with connective tissue disease (CTD) have gastric esophageal reflux disease (GERD) symptoms despite receiving proton pump inhibitors (PPIs). Although pre-meal administration of PPIs is recommended in Western countries, the benefit of this administration timing in Japanese CTD patients with refractory GERD symptoms has not been proven.Objective
To determine whether pre-dinner administration of PPIs is more efficacious for refractory GERD symptoms in Japanese CTD patients.Methods
CTD patients receiving oral PPIs were instructed to take PPIs 1 h before dinner. Gastrointestinal symptoms were evaluated with frequency scale for the symptoms of GERD (FSSG) and gastrointestinal symptom rating scale (GSRS) before and after the intervention.Results
Pre-dinner administration of PPIs significantly improved FSSG total score, from a median of 8 to 6.5 (P = 0.005). Pre-dinner administration was more effective in patients with overt GERD symptoms (from median 18 to 10, P < 0.001) than in those with mild GERD symptoms (from median 2 to 2, P = 0.201). In addition to reflux syndrome, pre-dinner administration of PPIs significantly decreased abdominal pain syndrome and constipation syndrome of GSRS.Conclusion
Pre-dinner administration of PPIs may increase their efficacy in Japanese CTD patients with GERD, especially those with overt symptoms. 相似文献14.
Hua Xu Teng Zeng Jun-Ying Liu Yu Lei Shan Zhong Yun-Jian Sheng Zhi Zhou Hong Ren 《Digestive diseases and sciences》2014,59(2):242-258
Background
Mother-to-child transmission (MTCT) is the main mode of spread of hepatitis B virus (HBV) in China. We performed a meta-analysis to compare the effects of three measures for prevention of MTCT.Methods
A meta-analysis was performed on randomized controlled trials and non-randomized studies comparing the index of MTCT among five groups of pregnant women: hepatitis B immunoglobulin (HBIG) administration, antiviral treatment, placebo, elective caesarean section, and vaginal delivery.Results
Compared with the control group, the incidence of HBV intrauterine infection (RR = 0.42, 95 % CI 0.27–0.64, P < 0.0001) and the number of chronic hepatitis B (CHB) infants (RR = 0.44, 95 % CI 0.32–0.61, P < 0.00001) were lower in the HBIG administration group. In the antiviral treatment group, serum HBV DNA levels were lower (MD = ?4.01, 95 % CI ?5.07 to ?2.94, P < 0.00001) at the time of delivery, and normalization of ALT levels was better (RR = 1.11, 95 % CI 1.06–1.17, P < 0.0001). Infant serum HBsAg positivity (RR = 0.45, 95 % CI 0.22–0.91, P = 0.03) and incidence of infant HBV transmission RR = 0.06, 95 % CI 0.01–0.24, P < 0.0001) were reduced in antiviral the treatment group. Infant serum anti-HBs positivity at birth (RR = 1.24, 95 % CI 0.89–1.74, P = 0.2) or at 6–7 months (RR = 0.98, 95 % CI 0.86–1.11, P = 0.73) was not significantly different between the caesarean section and vaginal delivery groups. The incidence of infant CHB infection may have been higher in the vaginal delivery group (RR = 2.20, 95 % CI 1.02–4.74, P = 0.04).Conclusions
Administration of HBIG or antiviral therapy to HBV carrier mothers during pregnancy is effective in reducing MTCT. 相似文献15.
Graziella Isgro Vincenza Calvaruso Lorenzo Andreana Tu Vinh Luong Matteo Garcovich Pinelopi Manousou Angela Alibrandi Sergio Maimone Laura Marelli Neil Davies David Patch Amar Paul Dhillon Andrew Kenneth Burroughs 《Journal of gastroenterology》2013,48(8):921-929
Background
Collagen proportionate area (CPA) has a better correlation with hepatic venous pressure gradient (HVPG) than with Ishak stage. Liver stiffness measurement (LSM) is proposed as non invasive marker of portal hypertension/disease progression. Our aim was to compare LSM and CPA with Ishak staging in chronic viral hepatitis, and HVPG in HCV hepatitis after transplantation.Methods
One hundred and sixty-nine consecutive patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections pre/post liver transplantation (LT), had a liver biopsy combined with LSM (transient elastography), CPA (biopsies stained with Sirius Red and evaluated by digital image analysis and expressed as CPA) and HVPG (measured contemporaneously with transjugular biopsies in LT HCV patients).Results
LSM was dependent on CPA in HBV (r 2 = 0.61, p < 0.0001), HCV (r 2 = 0.59, p < 0.0001) and LT groups (r 2 = 0.64, p < 0.0001). In all three groups, CPA and Ishak were predictors of LSM, but multivariately CPA was better related to LSM (HBV: r 2 = 0.61, p < 0.0001; HCV: r 2 = 0.59, p < 0.0001; post-LT: r 2 = 0.68, p < 0.0001) than Ishak stage. In the LT group, multiple regression analysis including HVPG, LSM, aspartate aminotransferase to platelet ratio index (APRI) and Ishak stage/grade, showed that only CPA was related to HVPG (r 2 = 0.41, p = 0.01), both for HVPG ≥6 mmHg (OR 1.34, 95 % CI 1.14–1.58; p < 0.0001) or ≥10 mmHg (OR 1.25, 95 % CI 1.06–1.47; p = 0.007).Conclusion
CPA was related to LSM in HBV or HCV hepatitis pre/post-LT. CPA was better related to LSM than Ishak stage. In the LT HCV group, CPA was better related to HVPG than Ishak stage/grade, LSM or APRI. CPA may represent a better comparative histological index for LSM, rather than histological stages. 相似文献16.
Bon Shoji Fusao Ikeda Shin-ichi Fujioka Haruhiko Kobashi Tetsuya Yasunaka Yasuhiro Miyake Hidenori Shiraha Akinobu Takaki Kazuhiro Nouso Yoshiaki Iwasaki Kazuhide Yamamoto 《Journal of gastroenterology》2010,45(11):1172-1182
Background
For patients with chronic hepatitis due to hepatitis B virus (HBV), factors predicting hepatocellular carcinoma (HCC) other than high levels of HBV-DNA and alanine aminotransferase (ALT) are needed to prevent HCC development, as many patients with chronic HBV infection fulfill these conditions. The purpose of this study was to clarify factors predictive of HCC development for those patients.Methods
The study was a systematic cohort analysis of 303 consecutive patients with hepatitis B e-antigen, receiving laparoscopic examination for assessment of liver disease. Laparoscopic, histological, and clinical characteristics were investigated as related to HCC development.Results
HCC occurred in 27 patients during a mean follow-up of 8.0 ± 5.0 years, at the age of 37–72 years. Significant associations with HCC development were shown for liver cirrhosis, histological activity grade, reddish markings, and older age. Multivariate analysis revealed that HCC development was strongly associated with older age and male gender (P = 0.002 and P = 0.043, respectively). HCC occurred more frequently in patients of age ≥30 years even with early stage than in patients of age <30 years (P = 0.031). Severe reddish markings, a laparoscopic finding of widespread parenchymal destruction, were highly associated with HCC development in patients of age ≥30 years at diagnosis (odds ratio = 1.67, P = 0.034), while histological activity grade and ALT level were not (P = 0.075 and P = 0.69, respectively).Conclusions
HCC development is associated with older age, male gender, and liver cirrhosis. Reddish markings, rather than histological activity or ALT level, can be useful to predict HCC for HBV patients of age ≥30 years. 相似文献17.
Kyung-Yup Kim Jae Young Jang Jung-Wook Kim Jae-Jun Shim Chang Kyun Lee Seok Ho Dong Hyo Jong Kim Byung-Ho Kim Young Woon Chang 《Digestive diseases and sciences》2013,58(5):1282-1286
Background/Aim
As the prevalence of reflux esophagitis increases, so does the use of gastric acid suppressants. This study aimed to document the prevalence of Candida esophagitis (CE) at a single Korean university hospital over the last 5 years and to evaluate its risk factors.Methods
To investigate the prevalence of CE, we conducted a retrospective analysis of 55,314 individuals who underwent a screening esophagogastroduodenoscopy as part of a health check-up between January 2006 and December 2010 at Kyung Hee University Hospital in Seoul, Korea. A total of 250 patients who were treated for CE between January 2008 and August 2011 and 500 age- and sex-matched non-CE patients were enrolled in this study. The rates of recent gastric acid suppression therapy and other well-known risk factors in the two groups were compared.Results
The prevalence of CE was 0.35 % and increased each year (linear-by-linear association, P = 0.001). Univariate analysis showed that gastric acid suppression therapy, malignancy, DM and steroid therapy were related to CE. Multivariate analysis also showed that gastric acid suppression therapy (OR 5.11, 95 % CI 2.92–8.93 and P < 0.001), malignancy (OR 18.68, 95 % CI 6.37–54.75 and P < 0.001), DM (OR 2.67, 95 % CI 1.70–4.21 and P < 0.001) and steroids therapy (OR 6.74, 95 % CI 1.37–33.05 and P = 0.019) were related to CE.Conclusions
The prevalence of CE in Korea is increasing. Also, our results indicate that acid suppression therapy is a meaningful risk factor for CE. 相似文献18.
Rachel Halpern Smita Kothari Mahesh Fuldeore Victoria Zarotsky Victoria Porter Omar Dabbous Jay L. Goldstein 《Digestive diseases and sciences》2010,55(2):328-337
Purpose
Patient flow between primary care physicians and gastroenterologists in the continuum of gastroesophageal reflux disease (GERD) care is poorly understood. Using administrative claims data from a large US health plan linked with data abstracted from medical records, we examined: health care resource utilization for GERD subjects treated by primary care physicians (PCPs) and gastroenterologists (GEs), determinants of GERD subject transfer between these physician types, and reasons for GERD therapy change.Results
Within a sample of 169,884 patients, 211,043 PCP-based episodes of care and 40,304 GE-based episodes of care were developed. In unadjusted comparisons, GE episodes were characterized by more endoscopic procedures, on average (50.5/100 episodes), compared with PCP episodes (6.3/100, P < 0.001). Multivariate analysis showed that patients with esophagitis had 57.3% higher odds (P < 0.01) of transfer from PCP to GE compared with patients without esophagitis; patients with esophageal stricture had 98.6% higher odds (P < 0.01) of PCP-GE transfer. Patients with endoscopy during a first GE episode had 32.2% higher odds of transfer to a PCP (P < 0.01). The principal reasons for change in GERD therapy were no change or worsening of symptoms (51.7% of PCP charts; 9.5% of GE charts) and lack of response to therapy (51.7% of PCP charts, 26.2% of GE charts).Conclusion
Resource utilization varies greatly based on the physician’s specialty. We infer that timely transfer of GERD patients to gastroenterologists when empiric treatment is insufficient may lead to more efficient clinical management. 相似文献19.
Shahin Ayazi Jeffrey A. Hagen Parakrama Chandrasoma Parviz Gholami Joerg Zehetner Arzu Oezcelik John C. Lipham Steven R. DeMeester Tom R. DeMeester Michael M. Kline 《Digestive diseases and sciences》2010,55(4):967-972