The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent cause...The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used in most transplant recipients.Therefore,there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirinresistant HEV.In this review article,a literature search using PubMed and MEDLINE databases was performed,up to March 2020.Only the articles published in English were reviewed.展开更多
Pandemics obligate providers to transform their clinical practice.An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019(COVID-19)rel...Pandemics obligate providers to transform their clinical practice.An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019(COVID-19)related gastrointestinal conditions.Diarrhea,hepatitis,and pancreatitis can be seen in the COVID-19 course.Endoscopic procedures increase the risk of contamination for medical staff and patients despite precautions,therefore indications should be tailored to balance risks vs benefits.Furthermore,whether the immunosupression in inflammatory bowel diseases,liver transplantation,and autoimmune liver diseases increases COVID-19 related risks and how to modify immunosupression are topics of ongoing debate.This review aims to provide most up to date practical approaches that a gastrointestinal fellow should be aware on the problems and management of gastrointestinal and hepatobiliary diseases during the COVID-19 pandemic.展开更多
Coronavirus disease 2019(COVID-19)continues to pose a significant threat to global health.Primary prevention remains as a major strategy against the pandemic.Current evidence proves that aerosol and droplet-based rout...Coronavirus disease 2019(COVID-19)continues to pose a significant threat to global health.Primary prevention remains as a major strategy against the pandemic.Current evidence proves that aerosol and droplet-based routes are the main means of transmission of COVID-19 but other ways should be sought in order to prevent possible collateral transmission.The gastrointestinal system may be one such route.Angiotensin converting enzyme 2 is the target entry receptor for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)that is abundantly expressed in the gastrointestinal tract.SARS-CoV-2 is able to infect human enterocytes similar to severe acute respiratory syndrome and Middle Eastern respiratory syndrome.Herein this review,we discuss the current knowledge regarding the role of gastrointestinal transmission in transmission and pathophysiology of COVID-19.展开更多
文摘The hepatitis E virus(HEV)is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s.Globally,it is one of the most frequent causes of acute viral hepatitis.The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus.Among the eight different genotypes identified to date,HEV genotype 1(HEV1),HEV2,HEV3,and HEV4 are the most frequent genotypes causing infections in humans.HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies.They are also responsible for severe hepatitis in pregnant patients and infants.In contrast,HEV3 and HEV4 are zoonotic,and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals.Their main reservoir is the pig,and they are mostly encountered in developed countries.The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women,infants,older people,immunocompromised individuals,patients with underlying chronic liver diseases,and workers that come into close contact with HEV-infected animals.In the clinical perspective,HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis,acute-on-chronic liver disease,chronic hepatitis,cirrhosis,and liver failure.Although HEV mainly results in acute selflimiting infection,chronic HEV infection may occur among immunocompromised patients(e.g.,solid-organ transplant recipients).Additionally,HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade,although the causal link for many of them still needs to be proven.Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success.However,ribavirin is contraindicated in pregnant patients,and interferon-alpha cannot be used in most transplant recipients.Therefore,there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirinresistant HEV.In this review article,a literature search using PubMed and MEDLINE databases was performed,up to March 2020.Only the articles published in English were reviewed.
文摘Pandemics obligate providers to transform their clinical practice.An extensive effort has been put to find out feasible approaches for gastrointestinal diseases and also to manage coronavirus disease 2019(COVID-19)related gastrointestinal conditions.Diarrhea,hepatitis,and pancreatitis can be seen in the COVID-19 course.Endoscopic procedures increase the risk of contamination for medical staff and patients despite precautions,therefore indications should be tailored to balance risks vs benefits.Furthermore,whether the immunosupression in inflammatory bowel diseases,liver transplantation,and autoimmune liver diseases increases COVID-19 related risks and how to modify immunosupression are topics of ongoing debate.This review aims to provide most up to date practical approaches that a gastrointestinal fellow should be aware on the problems and management of gastrointestinal and hepatobiliary diseases during the COVID-19 pandemic.
文摘Coronavirus disease 2019(COVID-19)continues to pose a significant threat to global health.Primary prevention remains as a major strategy against the pandemic.Current evidence proves that aerosol and droplet-based routes are the main means of transmission of COVID-19 but other ways should be sought in order to prevent possible collateral transmission.The gastrointestinal system may be one such route.Angiotensin converting enzyme 2 is the target entry receptor for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)that is abundantly expressed in the gastrointestinal tract.SARS-CoV-2 is able to infect human enterocytes similar to severe acute respiratory syndrome and Middle Eastern respiratory syndrome.Herein this review,we discuss the current knowledge regarding the role of gastrointestinal transmission in transmission and pathophysiology of COVID-19.
