AIM To evaluate the performance of aspartate aminotransferase to platelet ratio(APRI) score against FibroS can in predicting the presence of fibrosis. METHODS Data of patients who concurrently had APRI score, Fibro Sc...AIM To evaluate the performance of aspartate aminotransferase to platelet ratio(APRI) score against FibroS can in predicting the presence of fibrosis. METHODS Data of patients who concurrently had APRI score, Fibro Scan and liver biopsy to assess their hepatitis C virus(HCV) and hepatitis B virus(HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3. RESULTS Of the 3619 patients(47.5 ± 11.3 years, 97M:36F) who had Fibro Scans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133(20%, F3 = 21 and F4 = 6) patients. Although APRI score(P < 0.001, AUC = 0.83) and FibroS can(P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest(APRI score: 51.9% sensitivity, 84.9% specificity; FibroS can: 63% sensitivity, 84% specificity). Whilst 13/27(48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroS can in 43% of patients. CONCLUSION APRI score and Fibro Scan performed equally well in predicting advanced fibrosis. A proposed APRI cutoff score of 0.5 could be used as a screening tool for FibroS can, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.展开更多
Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the ...Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between Eo E and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.展开更多
文摘AIM To evaluate the performance of aspartate aminotransferase to platelet ratio(APRI) score against FibroS can in predicting the presence of fibrosis. METHODS Data of patients who concurrently had APRI score, Fibro Scan and liver biopsy to assess their hepatitis C virus(HCV) and hepatitis B virus(HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3. RESULTS Of the 3619 patients(47.5 ± 11.3 years, 97M:36F) who had Fibro Scans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133(20%, F3 = 21 and F4 = 6) patients. Although APRI score(P < 0.001, AUC = 0.83) and FibroS can(P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest(APRI score: 51.9% sensitivity, 84.9% specificity; FibroS can: 63% sensitivity, 84% specificity). Whilst 13/27(48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroS can in 43% of patients. CONCLUSION APRI score and Fibro Scan performed equally well in predicting advanced fibrosis. A proposed APRI cutoff score of 0.5 could be used as a screening tool for FibroS can, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.
文摘Eosinophilic oesophagitis(EoE) and gastro-oesophageal reflux disease(GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between Eo E and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.
