Seroprevalence of Viral Hepatitis B and C among Blood Donors at the Agadir Regional Transfusion Center

Introduction: The prevention of transmission of infections transmitted by blood transfusion depends on the correct selection of donors and the performance of adequate serological tests for the detection of pathogens, in particular viral hepatitis B and C viruses. The main objective of our study was to evaluate the seroprevalences of viral markers B and C in blood donors in the Agadir region. The secondary objectives were to evaluate these prevalences according to the socio-demographic characteristics of the donors and to evaluate the seroprevalence of other markers, in particular the human immunodeficiency virus. Methods: A retrospective analysis of files from the blood donor registers of the Agadir regional transfusion center, covering the period from 1 January to 31 December 2020, was conducted. Results: The study included 13,092 donors, the mean age was 34 ± 11, the M/F sex ratio was 2.6. The overall seroprevalences of HBsAg, anti-HCV, anti-HIV were respectively: 1.3%, 0.2% and 0.3% respectively. For HBsAg, the prevalence was higher in men (p = 0.007). The prevalence of anti-HCV was higher in rural areas than in urban areas (p Conclusion: The low prevalences of viral markers B and C in our study compared to those recorded in the general Moroccan population reflect the effectiveness of preventive measures with regard to donor selection.

Prevalence of occult hepatitis B virus infection

Occult hepatitis B virus(HBV) infection(OBI) is characterized by the persistence of HBV DNA in the liver tissue in individuals negative for the HBV surface antigen.The prevalence of OBI is quite variable depending on the level of endemic disease in different parts of the world,the different assays utilized in the studies,and the different populations studied.Many studies have been carried out on OBI prevalence in different areas of the world and categories of individuals.The studies show that OBI prevalence seems to be higher among subjects at high risk for HBV infection and with liver disease than among individuals at low risk of infection and without liver disease.

Role of gastrin-peptides in Barrett's and colorectal carcinogenesis

Gastrin is the main hormone responsible for the stimulation of gastric acid secretion;in addition,gastrin and its derivatives exert proliferative and antiapoptotic effects on several cell types.Gastrin synthesis and secretion are increased in certain situations,for example,when proton pump inhibitors are used.The impact of sustained hypergastrinemia is currently being investigated.In vitro experiments and animal models have shown that prolonged hypergastrinemia may be related with higher cancer rates;although,this relationship is less clear in human beings.Higher gastrin levels have been shown to cause hyperplasia of several cell types;yet,the risk for developing cancer seems to be the same in normo-and hypergastrinemic patients.Some tumors also produce their own gastrin,which can act in an autocrine manner promoting tumor growth.Certain cancers are extremely dependent on gastrin to proliferate.Initial research focused only on the effects of amidated gastrins,but there has been an interest in intermediates of gastrin in the last few decades.These intermediates aren't biologically inactive;in fact,they may exert greater effects on proliferation and apoptosis than the completely processed forms.In certain gastrin overproduction states,they are the most abundant gastrin peptides secreted.The purpose of this review is to examine the gastrin biosynthesis process and to summarize the results from different studies evaluating the production,levels,and effects of the main forms of gastrin in different overexpression states and their possible relationship with Barrett's and colorectal carcinogenesis.

Pathogenesis of occult chronic hepatitis B virus infection

Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays;but more frequently it is due to a strong suppression of viral replication and gene expression.OBI is an entity with world-wide diffusion.The failure to detect HBsAg,despite the persistence of the viral DNA,is due in most cases to the strong suppression of viral replication and gene expression that characterizes this"occult"HBV infection;although the mechanisms responsible for suppression of HBV are not well understood.The majority of OBI cases are secondary to overt HBV infection and represent a residual low viremia level suppressed by a strong immune response together with histological derangements which occurred during acute or chronic HBV infection.Much evidence suggests that it can favour the progression of liver fibrosis and the development of hepatocellular carcinoma.

Experimental evidence of obesity as a risk factor for severe acute pancreatitis

The incidence of acute pancreatitis,an inflammation of the pancreas,is increasing worldwide.Pancreatic injury is mild in 80%-90% of patients who recover without complications.The remaining patients may develop a severe disease with local complications such as acinar cell necrosis,abscess and remote organ injury including lung injury.The early prediction of the severity of the disease is an important goal for physicians in management of patients with acute pancreatitis in order to optimize the therapy and to prevent organ dysfunction and local complications.For that purpose,multiple clinical scale scores have been applied to patients with acute pancreatitis.Recently,a new problem has emerged:the increased severity of the disease in obese patients.However,the mechanisms by which obesity increases the severity of acute pancreatitis are unclear.Several hypotheses have been suggested:(1) obese patients have an increased inflammation within the pancreas;(2) obese patients have an increased accumulation of fat within and around the pancreas where necrosis is often located;(3) increase in both peri-and intra-pancreatic fat and inflammatory cells explain the high incidence of pancreatic inflammation and necrosis in obese patients;(4) hepatic dysfunction associated with obesity might enhance the systemic inflammatory response by altering the detoxification of inflammatory mediators;and(5) ventilation/perfusion mismatch leading to hypoxia associated with a low pancreatic flow might reduce the pancreatic oxygenation and further enhance pancreatic injury.Recent experimental investigations also show an increased mortality and morbidity in obese rodents with acute pancreatitis and the implication of the adipokines lep-tin and adiponectin.Such models are important to investigate whether the inflammatory response of the disease is enhanced by obesity.It is exciting to speculate that manipulation of the adipokine milieu has the potential to influence the severity of acute pancreatitis.

Age,smoking and overweight contribute to the development of intestinal metaplasia of the cardia

AIM:To assess the role of Helicobacter pylori(H.pylori),gastroesophageal reflux disease(GERD),age,smoking and body weight on the development of intestinal metaplasia of the gastric cardia(IMC).METHODS:Two hundred and seventeen patients scheduled for esophagogastroduodenoscopy were enrolled in this study.Endoscopic biopsies from the esophagus,gastroesophageal junction and stomach were evaluated for inflammation,the presence of H.pylori and intestinal metaplasia.The correlation of these factors with the presence of IMC was assessed using logistic regression.RESULTS:IMC was observed in 42% of the patients.Patient age,smoking habit and body mass index(BMI) were found as potential contributors to IMC.The risk of developing IMC can be predicted in theory by combining these factors according to the following formula:Risk of IMC = a + s-2B where a = 2,…6 decade of age,s = 0 for non-smokers or ex-smokers,1 for < 10 cigarettes/d,2 for > 10 cigarettes/d and B = 0 for BMI < 25 kg/m2(BMI < 27 kg/m2 in females),1 for BMI > 25 kg/m2(BMI > 27 kg/m2 in females).Among potential factors associated with IMC,H.pylori had borderline signif icance(P = 0.07),while GERD showed no signif icance.CONCLUSION:Age,smoking and BMI are potential factors associated with IMC,while H.pylori and GERD show no significant association.IMC can be predicted in theory by logistic regression analysis.

Clinical significance of occult hepatitis B virus infection

Occult hepatitis B virus(HBV) infection(OBI) is defined as the presence of HBV DNA in the liver(with or without detectable HBV DNA in serum) for individuals testing HBV surface antigen negative.Until recently,the clinical effect of OBI was unclear on the progression of liver disease;on the development of hepatocellular carcinoma;and on the risk for reactivation or transmission of HBV infection.Several studies suggest a high prevalence of OBI among patients with cryptogenic chronic liver disease,but its role in the progression to cirrhosis remains unclear.Although OBI has been well documented in human immunodeficiency virus(HIV) -positive patients,especially among those coinfected with hepatitis C virus,further studies are needed to determine its current clinical impact in HIV setting.

Recurrent Clostridium difficile infections:The importance of the intestinal microbiota

Clostridium difficile infections(CDI)are a leading cause of antibiotic-associated and nosocomial diarrhea.Despite effective antibiotic treatments,recurrent infections are common.With the recent emergence of hypervirulent isolates of C.difficile,CDI is a growing epidemic with higher rates of recurrence,increasing severity and mortality.Fecal microbiota transplantation(FMT)is an alternative treatment for recurrent CDI.A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach.FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI.Since the first reported use of FMT for recurrent CDI in 1958,systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment.This article focuses on current guidelines for CDI treatment,the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy,adverse effects and acceptability.

Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence

Harmful alcohol drinking may lead to significant damage on any organ or system of the body.Alcoholic liver disease(ALD) is the most prevalent cause of advanced liver disease in Europe.In ALD,only alcohol abstinence was associated with a better long-term survival.Therefore,current effective therapeutic strategy should be oriented towards achieving alcohol abstinence or a significant reduction in alcohol consumption.Screening all primary care patients to detect those cases with alcohol abuse has been proposed as population-wide preventive intervention in primary care.It has been suggested that in patients with mild alcohol use disorder the best approach is brief intervention in the primary care setting with the ultimate goal being abstinence,whereas patients with moderate-to-severe alcohol use disorder must be referred to specialized care where detoxification and medical treatment of alcohol dependence must be undertaken.

Superoxide dismutase prevents development of adenocarcinoma in a rat model of Barrett's esophagus

AIM: To test whether antioxidant treatment could prevent the progression of Barrett's esophagus to adenocarcinoma.METHODS: In a rat model of gastroduodenoesophageal reflux by esophagojejunal anastomosis with gastric preservation, groups of 6-10 rats were randomized to receive treatment with superoxide dismutase (SOD) or vehicle and followed up for 4 mo. Rat's esophagus was assessed by histological analysis, superoxide anion and peroxinitrite generation, SOD levels and DNA oxidative damage.RESULTS: All rats undergoing esophagojejunostomy developed extensive esophageal mucosal ulceration and inflammation by mo 4. The process was associated with a progressive presence of intestinal metaplasia beyondthe anastomotic area (9% 1st mo and 50% 4th mo) (94% at the anastomotic level) and adenocarcinoma(11% 1st mo and 60% 4th mo). These changes were associated with superoxide anion and peroxinitrite mucosal generation, an early and significant increase of DNA oxidative damage and a significant decrease in SOD levels (P＜0.05). Exogenous administration of SOD decreased mucosal superoxide levels, increased mucosal SOD levels and reduced the risk of developing intestinal metaplasia beyond the anastomotic area (odds ratio = 0.326; 95%CI: 0.108-0.981; P = 0.046),and esophageal adenocarcinoma (odds ratio = 0.243;95%CI: 0.073-0.804; P = 0.021).CONCLUSION: Superoxide dismutase prevents the progression of esophagitis to Barrett's esophagus and adenocarcinoma in this rat model of gastrointestinal reflux, supporting a role of antioxidants in the chemoprevention of esophageal adenocarcinoma.

High prevalence of cholestasis, with increased conjugated bile acids in inflammatory bowel diseases patients

AIM To investigate the prevalence and causes of cholestasis in patients with inflammatory bowel diseases in the Swiss Inflammatory Bowel Diseases Cohort. METHODS A retrospective cohort study was performed of all the patients in the Swiss Inflammatory bowel disease Cohort. Total bile acid was measured for all patients and cholestasis was defined as a concentration > 8 μmol/L. The characteristics of patients with or without cholestasis were compared. Bile acid profiles were then determined for 80 patients with high total bile acid and 80 matched patients with low total bile acid. Bile acid profiles were compared for smokers vs nonsmokers, ileal vs colonic disease, and inflammatory vs non inflammatory diseases.RESULTS Ninety-six patients had more than 8 μmol/L total bile acid, giving a prevalence of 7.15%. Patients with an obvious cause of cholestasis, such as primary sclerosing cholangitis, were then excluded, leaving 1190 participants with total bile acid < 8 μmol/L and 80 with total bile acid > 8 μmol/L. In multivariate analysis, calcium supplementation was significantly associated with cholestasis(odds ratio, 2.36, 95%CI: 1.00-5.21, P = 0.040) whereas current smoking significantly reduced the risk of cholestasis(odds ratio, 0.42, 95%CI: 0.17-0.91, P = 0.041). Levels of all conjugated bile acids were higher in the cholestasis group than in the control group. When we compared patients with ileal vs colonic disease, the former had higher levels of primary, secondary, and tertiary bile acids whereas patients with colonic disease had higher levels of conjugated bile acids.CONCLUSION Prevalence of cholestasis is high. Smoking appears to reduce cholestasis. Conjugated bile acids are higher in cholestasis and in colonic disease whereas unconjugated in ileal disease.

Influence of occult hepatitis B virus infection in chronic hepatitis C outcomes

Persistence of hepatitis B virus-DNA in the sera,peripheral blood mononuclear cells or in the liver of hepatitis B surface antigen(HBsAg) -negative patients with or without serological markers of previous exposure(antibodies to HBsAg and/or to HB-core antigen) defines the entity called occult hepatitis B infection(OBI).Co-infection with hepatitis B and hepatitis C viruses is frequent in highly endemic areas.While this co-infection increases the risk of liver disease progression,development of cirrhosis and hepatocellular carcinoma and also increases the rate of therapeutic failure to interferon-based treatments than either virus alone,a potentially negative effect of OBI on clinical outcomes and of therapeutic response to current antiviral regimes of patients with chronic hepatitis C remains inconclusive.

Adenocarcinoma of the third and fourth portions of the duodenum: The capsule endoscopy value

Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However,its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an adenocarcinoma of the third and fourth duodenal portions,emphasizing its diagnostic difficulty and the value of video capsule endoscopy. A man,40 years old,with no medical history,with abdominal discomfort and progressive fatigue,presented four months ago with one episode o f m o d e ra t e m e l e n a. T h e p hy s i c a l e x a m i n a t i o n was normal,except for mucosal pallor. Blood tests were consistent with microcytic,hypochromic iron deficiency anemia with 7.8 g/d L hemoglobin. The upper and lower endoscopy were normal. Additional work-up with video capsule endoscopy showed a polypoid lesion involving the third and fourth portions o f t h e d u o d e n u m. B i o p s y s h o w e d a m o d e ra t e l y differentiated adenocarcinoma. Abdominal computed tomography showed a wall thickening from the third duodenal portion to the proximal jejunum,without distant metastasis. The patient underwent segmental resection(distal duodenum and proximal jejunum) with duodenojejunostomy. The surgical specimen histology confirmed the biopsy diagnosis,with transmural infiltration,without nodal involvement. Conclusion: Adenocarcinoma of the third and fourth portions of the duodenum is difficult to diagnose and capsule endoscopy is of great value.

Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

AIM:To investigate usefulness of adherence to gastroesophageal reflux disease(GERD) guideline established by the Spanish Association of Gastroenterology.METHODS:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice.Patients(aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD(heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal symptoms.Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.RESULTS:Endoscopy was indicated in 123(41%) patients:50 with alarm symptoms,32 with age > 50 years without alarm symptom.Seventy-two patients(58.5%) had esophagitis(grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98% of cases.However,in the absence of alarm symptoms,endoscopy was indicated in 33% of patients > 50 years(not recommended by the guideline).Adherence for proton pump inhibitors(PPIs) therapy was 80%,but doses prescribed were lower(half) in 5% of cases and higher(double) in 15%.Adherence regarding duration of PPI therapy was 69%;duration was shorter than recommended in 1%(4 wk in esophagitis grades C-D) or longer in 30%(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant(95% vs 85%).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms;PPIs were prescribed at higher doses and longer duration.

Severity of ulcerative colitis is associated with a polymorphism at diamine oxidase gene but not at histamine N-methyltransferase gene

瞄准：为了在作为它为组织安 metabolising 酶编码的基因分析二普通多型性的角色，联系到风险开发 ulcerative (UC ) 和这些病人的临床的功课。方法：有从一个单个中心和 261 个健康志愿者招募的 UC 的 229 个无关的病人的一个队在组织安 N-methyltransferase (HNMT ) 和二胺氧化酶(ABP1 ) 为 Thr105Ile 和 His645Asp 氨基酸替换的存在被分析酶，分别地由扩大限制过程。所有病人是 phenotyped 并且列在后面在上面为至少 2 年(吝啬的时间 11 年) 。结果：在在 ulcerative 病人和健康个人之间的 ABP1 等位基因的分发没有有效差量[或(95% CI ) 为变体 alleles=1.22 (0.91-1.61 )] 。然而，变异 ABP1 等位基因与在要求了抑制免疫力的药的 58 个病人之中的高频率是在场的[或(95 % CI ) 为变异的等位基因的搬运人 2.41 (1.21-4.83；P=0.006 )] ，与重要基因剂量效果(P=0.0038 ) 。与在人的肠的本地组织安新陈代谢上的 ABP1 对 HNMT 的占优势的角色一致，为 HNMT 遗传型或变异的等位基因的搬运人的频率在病人，不管怎样临床的进化，和控制个人之中是类似的。结论：组织安 metabolising 酶 ABP1 的 His645Asp 多型性与 ulcerative 的严厉有关。

Dual regulatory role for phosphatase and tensin homolog in specification of intestinal endocrine cell subtypes

AIM:To investigate the impact of phosphatase and tensin homolog(Pten) in the specification of intestinal enteroendocrine subpopulations.METHODS:Using the Cre/loxP system,a mouse with conditional intestinal epithelial Pten deficiency was generated.Pten mutant mice and controls were sacrificed and small intestines collected for immunofluorescence and quantitative real-time polymerase chain reaction.Blood was collected on 16 h fasted mice by cardiac puncture.Enzyme-linked immunosorbent assay was used to measure blood circulating ghrelin,somatostatin(SST) and glucose-dependent insulinotropic peptide(GIP) levels.RESULTS:Results show an unexpected dual regulatory role for epithelial Pten signalling in the specification/differentiation of enteroendocrine cell subpopulations in the small intestine.Our data indicate that Pten positively regulates chromogranin A(CgA) expressing subpopulations,including cells expressing secretin,ghrelin,gastrin and cholecystokinin(CCK).In contrast,Pten negatively regulates the enteroendocrine subtype specification of non-expressing CgA cells such as GIP and SST expressing cells.CONCLUSION:The present results demonstrate that Pten signalling favours the enteroendocrine progenitor to specify into cells expressing CgA including those producing CCK,gastrin and ghrelin.

Markers of inflammation and cardiovascular disease in recently diagnosed celiac disease patients

AIM To evaluate novel risk factors and biomarkers of car-diovascular disease in celiac disease(CD) patients compared with healthy controls. METHODS Twenty adult patients with recent diagnosis of CD and 20 sex, age and body mass index-matched healthy controls were recruited during a period of 12 mo. Indicators of carbohydrate metabolism, hematological parameters and high sensitive C reactive protein were determined. Moreover, lipoprotein metabolism was also explored through evaluation of the lipid profile andthe activity of cholesteryl ester transfer protein and lipoprotein associated phospholipase A2, which is also considered a specific marker of vascular inflammation. The protocol was approved by the Ethic Committee from School of Pharmacy and Biochemistry, University of Buenos Aires and from Buenos Aires Italian Hospital, Buenos Aires, Argentina.RESULTS Regarding the indicators of insulin resistance, CD patients showed higher plasma insulin levels [7.2(5.0-11.3) m U/L vs 4.6(2.6-6.7) m U/L, P < 0.05], increased Homeostasis Model Assessment-Insulin Resistance [1.45(1.04-2.24) vs 1.00(0.51-1.45), P < 0.05] and lower Quantitative Sensitive Check index [0.33(0.28-0.40) vs 0.42(0.34-0.65), P < 0.05] indexes. Folic acid concentration [5.4(4.4-7.9) ng/m L vs 12.2(8.0-14.2) ng/m L, P < 0.01] resulted to be lower and High-sensitivity C reactive protein levels higher(4.21 ± 6.47 mg/L vs 0.98 ± 1.13 mg/L, P < 0.01) in the patient group. With respect to the lipoprotein profile, CD patients showed lower high density lipoprotein-cholesterol(HDL-C)(45 ± 15 mg/d L vs 57 ± 17 mg/d L, P < 0.05) and apo A-I(130 ± 31 mg/d L vs 155 ± 29 mg/d L, P < 0.05) levels, as well as higher total cholesterol/HDL-C [4.19(3.11-5.00) vs 3.52(2.84-4.08), P < 0.05] and apo B/apo A-I(0.75 ± 0.25 vs 0.55 ± 0.16, P < 0.05) ratios in comparison with control subjects. No statistically significant differences were detected in lipoprotein-associated lipid transfer protein and enzymes.CONCLUSION The presence and interaction of the detected alterations in patients with CD, would constitute a risk factor for the development of atherosclerotic cardiovascular disease.

Profile of Endoscopic Lesions and Prevalence of <i>H. pylori</i>Infection at the Digestive Endoscopy Unit of Panzi General Reference Hospital in Bukavu

Introduction: Thanks to the opening of the digestive endoscopy unit in the Reference General Hospital of Panzi in Bukavu in the Democratic Republic of the Congo, which inspired our work on the profile of endoscopic lesions observed in a series of 1000 patients correlated with clinical and demographic criteria with the contribution of pathology examinations of the 292 biopsies performed. The aim of our work is to evaluate the prevalence of significant endoscopic lesions as well as that of H. pylori infection. Material and Methods: This is a retrospective, descriptive and analytical study, ranging from the 16th of December 2014 to the 16th of June 2016. It covered 1000 patients who benefited from a high digestive endoscopy and 292 of them had a biopsy with pathological examination. The data obtained were recorded and analyzed using the Epi-info software and chi-square test. Results: fifty-five percent of these patients were women. 66% of the patients were under 50 years of age. Their major symptom was epigastric pain (89.2%), the most observed endoscopic lesion was erythematous gastritis (82%) therefore we have noticed 21.5% of significant lesions. Gastric cancer was present in 3.9% of cases and gastric ulcer in 4.2% of cases. The gastric tumor was correlated with age and sex (P-value at 0.000 and 0.013). The gastroduodenal ulcer was linked to age, NSAID and tobacco use (P-value at 0.0007, 0.001, 0.007). Esophageal mycosis was correlated with HIV status (P-value at 0.000). Helicobacter pylori gastritis was the most frequent (61.30%) and Helicobacter pylori were present in 63% of gastric biopsies. Conclusion: Upper digestive endoscopy is a major tool for the diagnosis of upper gastrointestinal disorders and should always be followed by a biopsy if there is a suspicious lesion for pathologic confirmation and adequate management.

Acute-on-chronic liver failure:Pathogenesis,prognostic factors and management

Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure(OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIRO concept(Predisposition, Insult, Response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.

Immune responses to Helicobacter pylori infection

Helicobacter pylori(H.pylori)infection is one of the most common infections in human beings worldwide.H.pylori express lipopolysaccharides and flagellin that do not activate efficiently Toll-like receptors and express dedicated effectors,such asγ-glutamyl transpeptidase,vacuolating cytotoxin(vacA),arginase,that actively induce tolerogenic signals.In this perspective,H.pylori can be considered as a commensal bacteria belonging to the stomach microbiota.However,when present in the stomach,H.pylori reduce the overall diversity of the gastric microbiota and promote gastric inflammation by inducing Nod1-dependent pro-inflammatory program and by activating neutrophils through the production of a neutrophil activating protein.The maintenance of a chronic inflammation in the gastric mucosa and the direct action of virulence factors(vacA and cytotoxinassociated gene A)confer pro-carcinogenic activities to H.pylori.Hence,H.pylori cannot be considered as symbiotic bacteria but rather as part of the pathobiont.The development of a H.pylori vaccine will bring health benefits for individuals infected with antibiotic resistant H.pylori strains and population of underdeveloped countries.