AIM: To review all cases of abdominal tuberculosis(ATB) for demographic details, diagnostic work up and evidence of vitamin D deficiency.METHODS: This was a retrospective analysis of all patients diagnosed with ATB fr...AIM: To review all cases of abdominal tuberculosis(ATB) for demographic details, diagnostic work up and evidence of vitamin D deficiency.METHODS: This was a retrospective analysis of all patients diagnosed with ATB from June 2003 to August 2013 at St George's Hospital, London. Demographic data was available from the local tuberculosis database. Further clinical information was collected from electronic patient records, including radiology, endoscopy, microbiology, histology, biochemistry and serology. Patients were classified as either confirmed ATB [if mycobacteria tuberculosis(MTB) was cultured from abdominal site] or presumed ATB(if suggestive findings or high clinical suspicion). Subtypes of ATB were classified as tuberculosis(TB) peritonitis, luminal TB, solid organ TB or from a combination of sites.RESULTS: There were a total of 65 cases identified in this time period, with a mean of 6.5 cases per year(range 4-9). Mean age 42 years, 49.2% females. Fifty-two point three percent were South Asian, 38.5% African. Forty-nine point two percent had gastrointestinal endoscopy, 30.8% paracentesis and 24.6% surgery in order to obtain samples. Forty-seven point seven percent were defined as confirmed ATB with positive culture of MTB from abdominal sites, the rest were treated as presumed ATB. Twenty-four point six percent had co-existing sputum culture positive for MTB, and 30.8% had an abnormal chest X-ray. Subtypes of ATB: 35.4% had TB peritonitis; 27.7% luminal TB; 3.1% solid organ TB; and 33.8% TB at a combination of abdominal sites. Thirteen point nine percent were human immunodeficiency virus positive, all with CD4 count less than 300 cells/μL. Seventy point five percent had severe vitamin D deficiency, and 25% were vitamin D deficient.CONCLUSION: ATB mainly affects young South Asian and African patients, with difficulties in confirming diagnosis despite a range of non-invasive and invasive diagnostic tests.展开更多
Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pat...Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC.展开更多
文摘AIM: To review all cases of abdominal tuberculosis(ATB) for demographic details, diagnostic work up and evidence of vitamin D deficiency.METHODS: This was a retrospective analysis of all patients diagnosed with ATB from June 2003 to August 2013 at St George's Hospital, London. Demographic data was available from the local tuberculosis database. Further clinical information was collected from electronic patient records, including radiology, endoscopy, microbiology, histology, biochemistry and serology. Patients were classified as either confirmed ATB [if mycobacteria tuberculosis(MTB) was cultured from abdominal site] or presumed ATB(if suggestive findings or high clinical suspicion). Subtypes of ATB were classified as tuberculosis(TB) peritonitis, luminal TB, solid organ TB or from a combination of sites.RESULTS: There were a total of 65 cases identified in this time period, with a mean of 6.5 cases per year(range 4-9). Mean age 42 years, 49.2% females. Fifty-two point three percent were South Asian, 38.5% African. Forty-nine point two percent had gastrointestinal endoscopy, 30.8% paracentesis and 24.6% surgery in order to obtain samples. Forty-seven point seven percent were defined as confirmed ATB with positive culture of MTB from abdominal sites, the rest were treated as presumed ATB. Twenty-four point six percent had co-existing sputum culture positive for MTB, and 30.8% had an abnormal chest X-ray. Subtypes of ATB: 35.4% had TB peritonitis; 27.7% luminal TB; 3.1% solid organ TB; and 33.8% TB at a combination of abdominal sites. Thirteen point nine percent were human immunodeficiency virus positive, all with CD4 count less than 300 cells/μL. Seventy point five percent had severe vitamin D deficiency, and 25% were vitamin D deficient.CONCLUSION: ATB mainly affects young South Asian and African patients, with difficulties in confirming diagnosis despite a range of non-invasive and invasive diagnostic tests.
文摘Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC.
