Clinical and Paraclinical Profiling of Patients with Viral Hepatitis B and C Attending Saint Camille Hospital in Ouagadougou (HOSCO)

The present study aims to describe the clinical and paraclinical profile of patients infected by viral hepatitis B and C and follow-up. The clinical and paraclinical data used in this description are from patients infected by viral hepatitis B and C of the HOSCO Hepato-Gastroenterological Department from May 15, 2021 to July 23, 2021. The informed consent was provided to each patient included in this study. “Univariate analyses were evaluated using Pearson’s Chi2 test” using R software version 4.0.2. During the study period, we identified 149 patients with viral hepatitis B and/or C who met our inclusion criteria. The sex ratio was 0.83 at the rate of 68 men for 81 women with the average age at 37.17 years ± 12.21 years. The most represented age group was 30 - 44 years (49.7%). The most incriminated risk factors were medical care by injection (62.58%), excision (31.90%), blood transfusion (4.29%) and scarification (1.23%). HBV infection was the majority with a frequency of 95.97%. The HBV viral load was measured in 91.95% of patients, 77.18% of whom had a detectable DNA viral load ≤ 2000 IU/mL. The clinical and biological course was good in patients after therapeutic initiation. HBV-HCV-HIV co-infection was 0.67%. Abdominal ultrasound was normal in 87.92% of patients. Fibrosis was minimal and moderate in 58.39% and 19.46% of patients. Among patients, 52.35% were on Tenofovir therapy, 2.68% on Sofosbuvir/Velpatasvir, 0.67% on ARVs and 44.29% did not require treatment. Viral hepatitis B and C are common, and both affect sex. Thus, new screening strategies need to be implemented to improve the diagnosis of hepatitis B and C. Effective strategies against viral hepatitis B and C must be developed, subsequently.

Magnetic resonance spectroscopy to study hepatic metabolism in diffuse liver diseases, diabetes and cancer

This review provides an overview of the current state of the art of magnetic resonance spectroscopy (MRS) in in vivo investigations of diffuse liver disease. So far, MRS of the human liver in vivo has mainly been used as a research tool rather than a clinical tool. The liver is particularly suitable for static and dynamic metabolic studies due to its high metabolic activity. Furthermore, its relatively superfi cial position allows excellent MRS localization, while its large volume allows detection of signals with relatively low intensity. This review describes the application of MRS to study the metabolic consequences of different conditions including diffuse and chronic liver diseases, congenital diseases, diabetes, and the presence of a distant malignancy on hepatic metabolism. In addition, future prospects of MRS are discussed. It is anticipated that future technical developments such as clinical MRS magnets with higher fi eld strength (3 T) and improved delineation of multicomponent signals such as phosphomonoester and phosphodiester using proton decoupling, especially if combined with price reductions for stable isotope tracers, will lead to intensifi ed research into metabolic syndrome, cardiovascular disease, hepato-biliary diseases, as well as non-metastatic liver metabolism in patients with a distant malignant tumor.

Hepatic resection beyond barcelona clinic liver cancer indication:When and how

Hepatocellular carcinoma(HCC)is the main common primary tumour of the liver and it is usually associated with cirrhosis.The barcelona clinic liver cancer(BCLC)classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease.According to this algorithm,hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension(PHT)or hyperbilirubinemia.BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors,as wide as those with macrovascular infiltration and PHT,could benefit from liver resection.Consequently,treatment guidelines should be revised and patients with intermediate/advanced stage HCC,when technically resectable,should receive the opportunity to be treated with radical surgical treatment.Nevertheless,the surgical treatment of HCC on cirrhosis is complex:The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage.The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication.In particular,the role of multidisciplinary approach to assure a proper indication,of the intraoperative ultrasound for intraoperative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.

Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients

BACKGROUND While clinical guidelines recommend hepatocellular carcinoma(HCC)surveillance for at-risk individuals,reported surveillance rates in the United States and Europe remain disappointingly low.AIM To quantify HCC surveillance in an Australian cohort,and assess for factors associated with surveillance underutilisation.METHODS All patients undergoing HCC surveillance liver ultrasounds between January 1,2018 to June 30,2018 at a tertiary hospital in Melbourne,Australia,were followed until July 31,2020,or when surveillance was no longer required.The primary outcome was the percentage of time up-to-date with HCC surveillance(PTUDS).Quantile regression was performed to determine the impact of factors associated with HCC surveillance underutilisation.RESULTS Among 775 at-risk patients followed up for a median of 27.5 months,the median PTUDS was 84.2%(IQR:66.3%-96.3%).85.0%of patients were followed up by specialist gastroenterologists.Amongst those receiving specialist care,quantile regression demonstrated differential associations at various quantile levels of PTUDS for several factors.Older age at the 25th quantile(estimate 0.002 per percent,P=0.03),and cirrhotic status at the 75th quantile(estimate 0.021,P=0.017),were significantly associated with greater percentage of time up-to-date.African ethnicity(estimate-0.089,P=0.048)and a culturally and linguistically diverse(CALD)background(estimate-0.063,P=0.01)were significantly associated with lower PTUDS at the 50th quantile,and again for CALD at the 75th quantile(estimate-0.026,P=0.045).CONCLUSION While median PTUDS in this Australian cohort study was 84.2%,awareness of the impact of specific factors across PTUDS quantiles can aid targeted interventions towards improved HCC surveillance.

Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in BCS-HCC.METHODS A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were included.The prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were evaluated.RESULTS In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular obstruction.The median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver transplantation.CONCLUSION HCC is not uncommon in patients with BCS.Radiological interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

Is there a place for serum laminin determination in patients with liver disease and cancer?

Laminin is a glycoprotein which has an important role in the mechanism of fibrogenesis and is,thus,related to hepatic fibrosis in addition to presenting increased levels in several types of neoplasias. However,its determination is not routinely considered in the study of hepatic fibrosis. In this review,the authors critically comment on the role of this glycoprotein compared to other markers of fibrosis through non-invasive procedures(Fibroscan). They also consider its clinical investigational potential and believe that the continuation of these investigations might contribute to a better understanding of the fibrogenic mechanism,which could in turn either lead to the identification of patients at risk of developing fibrosis non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis(NASH) or at least be used as an indicator for hepatic biopsy in such patients. Finally,the authors believe that serum laminin determination might contribute to the diagnosis of epithelial tumor metastasis and peritoneal carcinomatosis.

Management of Malnutrition in Liver Cancer Patients with Chronic Liver Diseases

Liver cancer is the fifth most common cancer and the third leading cause of cancer death globally. Malnutrition is found in 65-90% of patients with liver cancer and often enhances cancer occurrence and complications, deteriorates liver functions, and promotes early development of refractory ascites and hepatic encephalopathy (HE), increasing both morbidity and mortality. Malnutrition may develop as a result of poor dietary intake, anorexia, medications, side effects to chemotherapy, encephalopathy, as well as socioeconomic limitations. A dedicated clinical team should provide proper assessment of patient’s nutritional status and nutrition supplemental plan to restore liver health and prevent or treat malnutrition. Nutrition assessment is based on medical, nutritional, and medication histories, physical examination for body composition and signs of malnutrition, anthropometric measurements, radio-imaging, laboratory tests, and flow charts or algorithms on patient’s dietary intake and changes in bodyweight. Clinical management depends on patient’s disease and nutritional status. Patients with minor liver affection or compensated liver cirrhosis may have normal diet without any restrictions in carbohydrates, proteins, and fat, but preferably take other supplements supporting the liver. Patients with decompensated liver should consume 25-40 kcal/kg/day and 1.0-1.5 g protein/kg/day. For patients with acute episodes of HE, a temporary protein restriction of 0.6-0.8 g/kg/day should be implemented until HE is eliminated. Patients should consume small, frequent meals throughout the day and add a carbohydrate- and protein-rich evening snack. Other approaches to supporting optimal digestion and nutrition and managing side effects of cancer therapies may be added as well.

不同方式联合TACE治疗原发性肝癌合并上消化道出血的临床疗效

目的比较经颈内静脉肝内门体分流术(transjugular intrahepatic portal systemic shunt TIPS)、内镜治疗及药物治疗3种不同方式联合经肝动脉化疗栓塞术(transhepatic arterial chemoembolization TACE)对原发性肝癌合并门静脉高压、上消化道出血的临床疗效。方法纳入2014年1月至2020年6月联勤保障部队第九八〇医院原发性肝癌合并门静脉高压、上消化道出血患者105例,根据治疗方式分为TIPS联合TACE组25例,内镜联合TACE组30例,药物联合TACE组50例。比较3种不同治疗方式联合TACE治疗肝癌合并上消化道出血的临床疗效、出血复发率、肝性脑病发生率及生存率。结果3组患者治疗后6、12和24个月出血复发率差异有统计学意义(均P<0.05)。TIPS组患者治疗前门静脉压力为(38.47±9.35)mmHg(1 mmHg=0.133 kPa),治疗后为(25.24±5.68)mmHg,差异有统计学意义(P<0.05)。治疗后3组患者血红蛋白均不同程度升高,TIPS组及内镜组优于药物组,差异有统计学意义(P<0.05)。TIPS组术后6、12和24个月出血复发率低于内镜组及药物组,差异有统计学意义(P<0.05);12个月和24个月出血复发率低于内镜组,差异有统计学意义(P<0.05);内镜组12个月及24个月出血复发率低于药物组(P<0.05),两组6个月内出血复发率差异无统计学意义(P>0.05)。TIPS组6个月和12个月肝性脑病发生率高于内镜组及药物组,差异有统计学意义(P<0.05),内镜组与药物组差异无统计学意义(P>0.05);3组患者24个月肝性脑病发生率差异无统计学意义(P>0.05)。TIPS组与内镜组6个月病死率差异无统计学意义(P>0.05),两组均低于药物组,且差异有统计学意义(P<0.05);TIPS组12个月及24个月病死率低于内镜组及药物组,差异有统计学意义(P<0.05);内镜组与药物组差异无统计学意义(P>0.05)。结论TIPS联合TACE治疗原发性肝癌合并上消化道出血可降低上消化道出血复发率,有效控制肿瘤进展,延长生存期。

基于仲景“肝病实脾”理论探析现代临床肝病治法

肝硬化、脂肪肝、肝癌、慢性乙型病毒性肝炎等是全球常见肝病,随着患病率逐渐上升,中西医治疗肝病的研究成为热点。从中医学理论出发,以“肝脾相关”为切入点,探讨肝脾之间阴阳五行亢盛、经络交汇、气机运行、消化吸收等交互作用,探讨“肝脾相关”理论的科学内涵,为治疗现代肝病提供助力。通过对肝病专家治疗肝硬化、脂肪肝、慢乙肝,肝硬化腹水、肝癌等的临床用药进行分析,探索现代临床肝病证治规律,发掘“肝病实脾”的临床意义,为今后中医药在肝脏疾病治疗领域的应用提供有益参考。

不同肝脏疾病的肝脏血管周围晕征出现情况及其MRI表现

目的描述肝脏血管周围晕征(PVL)的病理机制和MRI表现,探讨其与在同肝脏疾病的出现情况,并评价PVL的临床意义。方法回顾性分析2019年1月至2020年1月九江市第三人民医院收治的197例肝脏相关疾病患者为研究对象,按疾病种类分为慢性乙型肝炎组(111例)、肝硬化组(57例)、肝脏肿瘤组(29例)。观察三组患者PVL的MRI的表现,研究患者上腹部MRI平扫及增强的影像资料,分析不同肝脏疾病及其不同程度的PVL情况。结果慢性乙型肝炎患者的PVL检出率为32.4%,肝肿瘤患者的PVL检出率为31.0%,肝硬化患者的PVL检出率为40.4%。肝硬化患者PVL的出现率未随着肝硬化分级评分增加而变化(P>0.05)。肝门梗阻患者的PVL出现率高于肝门区未受到侵犯的患者,差异有统计学意义(P<0.05)。结论PVL的MRI分布和表现在不同肝脏疾病中,有相应的特征性,对于慢性乙型肝炎疾病严重程度和预后评价,以及肝肿瘤是否侵犯肝门区的诊断有参考价值。

代谢组学在肝病中医证候研究中的应用述要

证候是中医临床诊断和治疗的核心内容,是机体在疾病发展过程中某一阶段的病理概括。代谢组学可以反映机体在不同生理病理状态下代谢物水平的变化情况,其整体性、综合性、动态性等特点与中医证候的特性高度契合。通过综述代谢组学在肝癌、肝硬化、肝炎等肝病中医证候研究中的应用情况,探讨肝病中医证候的内在机制及物质基础,助力中医客观化研究,进而指导中医临床决策。

质子泵抑制剂与肝硬化不良反应的研究进展

质子泵抑制剂(proton pump inhibitors,PPIs)作为临床最常用抑酸药物,常被肝硬化患者用于缓解各种腹部不适、预防食管胃底静脉曲张出血等。但是近年来,随着人们对PPI不良反应的深入研究,肝硬化患者如何安全、有效地使用PPI也引发了讨论。本文对近年来研究者对肝硬化患者使用PPI而诱发或加重的不良反应进行复习总结,为临床上肝硬化患者更安全、有效地应用PPI提供一定的指导意见。

肝硬化合并原发性肝癌患者CT动态增强扫描变化及诊断价值

目的观察肝硬化(HC)合并原发性肝癌(PLC)患者CT动态增强扫描变化,分析其诊断价值。方法回顾性分析2020年4月—2022年7月我院125例HC患者资料,所有受试者均行病理组织学检测及CT动态增强扫描,统计所有患者病灶大小及分布情况,CT动态增强扫描动脉期、静脉期、延迟期病灶检出情况,以病理检查为金标准,分析CT动态增强扫描对HC患者PLC的诊断价值、HC患者与HC并PLC患者血流灌注参数大小及不同肝功能CTP分级下血流灌注参数变化。结果125例HC患者共检出161个病灶,其中直径<1 cm 8个,1~3 cm 53个,4~5 cm 63个,>5 cm 37个,肝右前叶、肝右后叶者居多,分别为45及69个;CT动态增强扫描动脉期检出病灶149个,检出率92.55%;门脉期检出病灶134个,检出率83.23%;延迟期检出病灶142个,检出率88.20%;125例HC患者中病理学检查显示75例PLC阳性,50例PLC阴性,CT动态增强扫检测HC并PLC的敏感度为94.67%,特异度为94.00%,准确率为94.40%,阳性预测值为95.95%,阴性预测值为92.16%,Kappa值为0.884,具有较高的一致性;HC组HAP、HPI值均显著低于HC并PLC组,PVP、TLP值均显著高于HC并PLC组(P<0.05);125例HC并PLC患者中CTP A级41例,CTP B级46例,CTP C级38例,CTP A级HAP、HPI值显著低于CTP B、C级(P<0.05),PVP、TLP值均显著高于CTP B、C级(P<0.05),CTP B级HPI值与CTP C级比较,差异均无统计学意义(P>0.05)。结论CT动态增强扫描可多方位多角度显示HC病灶情况,且对PLC具有较好的诊断价值,其中肝脏血流灌注参数具有一定的特征性,可为PLC诊断和肝功能分级提供参考。

Present and future possibilities for early diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) represents the fifth most common cancer in the world,and the third most frequent oncological cause of death.The incidence of HCC is on the increase.HCC typically develops in patients with chronic liver diseases,and cirrhosis,usually with viral etiology,is the strongest predisposing factor.Nowadays HCC diagnosis is a multistage process including clinical,laboratory,imaging and pathological examinations.The prognosis of HCC is mostly poor,because of detection at an advanced,non-resectable stage.Potentially curative treatment(surgery) is limited and really possible only for cases with small HCC malignancies.For this reason,more effective surveillance strategies should be used to screen for early occurrence of HCC targeted to the population at risk.So far,the generally accepted serological marker is α-fetoprotein(AFP).Its diagnostic accuracy is unsatisfactory and questionable because of low sensitivity,therefore there is a strong demand by clinicians for new HCC-specific biomarkers.In this review,we will focus on other biomarkers that seem to improve HCC diagnosis,such as AFP-L3,des-γ-carboxyprothrombin,α-l-fucosidase,,γ-glutamyl transferase,glypican-3,squamous cell carcinoma antigen,a new generation of immunoglobulin M-immunocomplexes,and very promising geneexpression profiling.

Diagnostic and therapeutic management of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is an increasing health problem, representing the second cause of cancerrelated mortality worldwide. The major risk factorfor HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemoembolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines.

Update on global epidemiology of viral hepatitis and preventive strategies

Viral hepatitis is one of the major public health concerns around the world but until recently it has drawn little attention or funding from global health policymakers.Every year 1.4 million people die from viral hepatitisrelated cirrhosis and liver cancer.However,the majority of the infected population are unaware of their condition.This population have significant obstacles to overcome such as lack of awareness,vulnerability,increased migration,disease stigma,discrimination,as well as poor health resources,conflict in policy development and program implementation.Despite implementing infection control measures over the last few decades eradication or significant disease reduction remains elusive.This study aims to present the current global prevalence status and examines potential elimination strategies.The information for this research were obtained through a systematic review,published scientific literatures,the official websites of various government organisations,international public health organisations and internationally recognised regulatory bodies over a period of 40 years between 1978 and2018.

Non-cirrhotic hepatocellular carcinoma in chronic viral hepatitis: Current insights and advancements

Primary liver cancers carry significant morbidity and mortality.Hepatocellular carcinoma(HCC)develops within the hepatic parenchyma and is the most common malignancy originating from the liver.Although 80%of HCCs develop within background cirrhosis,20%may arise in a non-cirrhotic milieu and are referred to non-cirrhotic-HCC(NCHCC).NCHCC is often diagnosed late due to lack of surveillance.In addition,the rising prevalence of non-alcoholic fatty liver disease and diabetes mellitus have increased the risk of developing HCC on noncirrhotic patients.Viral infections such as chronic Hepatitis B and less often chronic hepatitis C with advance fibrosis are associated with NCHCC.NCHCC individuals may have Hepatitis B core antibodies and occult HBV infection,signifying the role of Hepatitis B infection in NCHCC.Given the effectiveness of current antiviral therapies,surgical techniques and locoregional treatment options,nowadays such patients have more options and potential for cure.However,these lesions need early identification with diagnostic models and multiple surveillance strategies to improve overall outcomes.Better understanding of the NCHCC risk factors,tumorigenesis,diagnostic tools and treatment options are critical to improving prognosis and overall outcomes on these patients.In this review,we aim to discuss NCHCC epidemiology,risk factors,and pathogenesis,and elaborate on NCHCC diagnosis and treatment strategies.

Chronic hepatitis B in 2014: Great therapeutic progress, large diagnostic deficit

This review analyzes progress and limitations of diagnosis, screening, and therapy of patients with chronic hepatitis B infection. A literature review was carried out by framing the study questions. Vaccination in early childhood has been introduced in most countries and reduces the infection rate. Treatment of chronic hepatitis B can control viral replication in most patients today. It reduces risks for progression and may reverse liver fibrosis. The treatment effect on development of hepatocellular carcinoma is less pronounced when cirrhosis is already present. Despite the success of vaccination and therapy chronic hepatitis B remains a problem since many infected patients do not know of their disease. Although all guidelines recommend screening in high risk groups such as migrants, these suggestions have not been implemented. In addition, the performance of hepatocellular cancer surveillance under real-life conditions is poor. The majority of people with chronic hepatitis B live in resource-constrained settings where effective drugs are not available. Despite the success of vaccination and therapy chronic hepatitis B infection remains a major problem since many patients do not know of their disease. The problems in diagnosis andscreening may be overcome by raising awareness, promoting partnerships, and mobilizing resources.

Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival

瞄准：在黎巴嫩和早死亡预兆的预示的因素学习 HCC 的传染病学。方法：在一个五年的时期上诊断的 HCC 盒子的观察后续队研究被执行。Multivariate 分析被进行与肝意大利的程序(片断) 分数的癌症相比识别预示的因素。包括内在的肝疾病，病人的人口统计的特征，和孩子呸评估的肝疾病的严厉的病原学的多重变量得分被学习。肿瘤参数包括了小瘤，门静脉血栓的存在，和治疗形式的 HCC， alpha-fetoprotein 水平，数字和尺寸的诊断的时间。后续的死亡或损失被看作一个端点事件。结果：92 个病人(平均数 60.5 +/- 22.3 年) 被包括。内在的疾病的病原学分别地是在 67% ， 20% ，和 23.5% 的肝炎 B， C，和酒精。在诊断的孩子呸班分别地是在 34.8% ， 39.3% 和 25.8% 的 A， B，和 C。全面幸存分别地在 1， 2 和 3 年是 44.8% ， 32.8% 和 17.6%( 吝啬的 F/U 40.2 +/- 23.5 瞬间) 。Multivariate 分析识别了早死亡的三个预言者(【 6 瞬间) ：胆红素 】 3.2 mg/dL (P 【 0.01 ) ， HCC 作为肝疾病的第一个演讲(P = 0.035 ) ，并且肌酸酐 】 1 mg/dL (P = 0.017 ) 。一个分数由考克斯基于这些变量超过了片断分数比例的危险。巨鸟曲线显示了两个模型相等、中等精确。结论：HBV 是在黎巴嫩的 HCC 的领先的原因。早死亡的独立预言者是象疾病的第一表明的提高的胆红素，肌酸酐和 HCC。一个分数的未来的确认基于在预言短期的幸存的这些临床的参数被需要。

Extragastric manifestations of Helicobacter pylori infection: Possible role of bacterium in liver and pancreas diseases

Helicobacter pylori(H. pylori) is an ancient microorganism that has co-evolved with humans for over 60000 years. This bacterium typically colonizes the human stomach and it is currently recognized as the most common infectious pathogen of the gastroduodenal tract. Although its chronic infection is associated with gastritis, peptic ulcer, dysplasia, neoplasia, MALT lymphoma and gastric adenocarcinoma, it has been suggested the possible association of H. pylori infection with several extragastric effects including hepatobiliary and pancreatic diseases. Since a microorganism resembling H. pylori was detected in samples from patients with hepatobiliary disorders, several reports have been discussed the possible role of bacteria in hepatic diseases as hepatocellular carcinoma, cirrhosis and hepatic encephalopathy, nonalcoholic fatty liver disease and fibrosis. Additionally, studies have reported the possible association between H. pylori infection and pancreatic diseases, especially because it has been suggested that this infection could change the pancreatic physiology. Some of them have related a possible association between the microorganism and pancreatic cancer. H. pylori infection has also been suggested to play a role in the acute and chronic pancreatitis pathogenesis, autoimmune pancreatitis, diabetes mellitus and metabolic syndrome. Considering that association of H. pylori to liver and pancreas diseases needs further clarification, our work offers a review about the results of some investigations related to the potential pathogenicity of H. pylori in these extragastric diseases.