Non-alcoholic fatty liver disease: What has changed in the treatment since the beginning?

Non-alcoholic fatty liver disease(NAFLD) is an umbrella term to describe the entire spectrum of this common liver disease. In patients with NAFLD, especially those with non-alcoholic steatohepatitis(NASH), most often have one or more components of the metabolic syndrome, but this is not universal. Although most patients with NAFLD share many clinical features, only a subset of patients develops significant liver inflammation and progressive fibrosis. On the other hand, not all patients with NASH exhibit insulin resistance. NASH can be seen in patients who are lean and have no identifiable risk factors. Many clinical studies have tried numerous drugs and alternative medicine, however, investigators have failed to identify a safe and effective therapy for patients with NASH. As summarized, the heterogeneity of pathogenic pathways in individual patients with NASH may warrant the development of an individualized treatment according to the underlying pathogenic pathway. The differentiation of pathogenetic targets may require the development of diagnostic and prognostic biomarkers, and the identification of genetic susceptibilities. At present, evidence-based medicine provides only a few options including life-style modifications targeting weight loss, pioglitazone and vitamin E in non-diabetic patients with biopsy-proven NASH.

Gastroesophageal reflux in asymptomatic obese subjects:An esophageal impedance-pH study

AIM:To investigate the relationship between reflux and body mass index(BMI) in the asymptomatic obese population using the impedance-p H technique.METHODS:Gastroesophageal reflux is frequent in the obese population.However,the relationship between acid reflux and BMI in asymptomatic obese people is unclear.Forty-six obese(BMI > 25 kg/m2) people were enrolled in this prospective study.We evaluated the demographic findings and 24-h impedance p H values of the whole group.Gas,acid(p H < 4),weak acid(p H = 4-7) and weak alkaline(p H ≥ 7) reflux parameters were analyzed.RESULTS:The mean age of patients was 49.47±12.24 years,and half of them were men.The mean BMI was 30.64±3.95 kg/m2(25.14-45.58 kg/m2).BMI of 23 was over 30 kg/m2.Seventeen patients had a comorbidity(hypertension,diabetes mellitus,or ischemic heart disease).Endoscopic examination revealed esophagitis in 13 of the 28 subjects(10Grade A,3 Grade B).The subjects were divided into two groups according to BMI(<30 and>30 kg/m2).Demographic and endoscopic findings,and impedance results were similar in these two groups.However,there was a positive correlation between BMI and total and supine p H<4 episodes(P=0.002,r=0.414;P=0.000,r=0.542),p H<4 reflux time(P=0.015,r=0.319;P=0.003,r=0.403),and De Meester score(P=0.012,r=0.333).CONCLUSION:Acid reflux is correlated with BMI in asymptomatic obese individuals.

Food impaction in older age:Think about an eosinophilic esophagitis

Eosinophilic esophagitis is an inflammatory condition of esophagus.It is generally seen in childhood and young population.Men are more commonly affected than women.However,it is not common in an advanced age.Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodation against foods.Therefore,the major symptom in adults with eosinophilic esophagitis is difficulty in swallowing solid food(dysphagia).Specifically,the food gets stuck in the esophagus after it is swallowed.Less common symptoms include heartburn and chest pain.Because of this,it may be incorrectly diagnosed as a gastroesophageal reflux disease.Here,we reported a case presented with food impaction at advanced age.As a conclusion,eosinophilic esophagitis is a rare entity that must be remembered in advance aged patients presenting with food impaction.

Intrahepatic and peripheral T-cell responses in genotype 1b hepatitis C virus-infected patients with persistently normal and elevated aminotransferase levels

AIM: To evaluate whether the cytokine responses in liver and serum differ in chronic hepatitis C patients with normal and high alanine aminotransferase (ALT) levels. METHODS: Thirty-three (16 with normal ALT level as group 1 and 17 with elevated ALT level as group 2) patients infected with genotype 1b hepatitis C virus (HCV) were examined. Liver infiltrating lymphomononuclear cells (LILMCs) were isolated from liver biopsy by collagenase type 1 and stimulated with phytohemagglutinin and interleukin 2 (IL-2). IL-10, IL-12, interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α) were determined in serum and LILMCs by ELISA. RESULTS: Serum cytokine levels were similar in both groups (P>0.05). Stimulated IFN-γ and TNF-α levels in LILMCs were increased in both groups. IL-12 and IL-10 levels stimulated with IL-2 were higher in group 1 than in group 2 (P = 0.023). Histological activity index (HAI) and stage had a negative correlation with TNF-α and IFN-γ levels in group 2. CONCLUSION: Increased T-helper type 2 (Th2) cytokine response may regress inflammatory and biochemical activity. Progression of histological abnormalities in persons with elevated ALT probably depends on insufficient Th2 cytokine response, which does not balance Th1 cytokine response.