Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management

Diagnosis of and therapy for nonalcoholic steatohepatitis

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. There is no definitive treatment for this, and prevention and treatment via diet and weight loss have been recommended. Objectives: This study aimed to investigate the effect of Dava Al-Balgham, as one of the traditional medicine products, in patients with NAFLD. Methods: The study was a randomized, double-blinded, placebo-controlled trial performed among 76 patients with NAFLD in a university-affiliated hospital, Qom, Iran, in 2017. The individuals were assigned into two groups of intervention (receiving Dava Al-Balgham; n = 37) and placebo (n = 39), using the randomized block allocation method. Both groups maintained the same diet and lifestyle. In the intervention group, two tablets of Dava Al-Balgham (a combination of Nigella sativa, Zataria multiflora, Pistacia lentiscus, and Trachyspermum ammi) were consumed with each meal for three months. In the other group, placebo tablets were used in the same manner. Pre- and post-intervention weight, waist circumference, and liver enzyme levels were measured. Chi-square, t-test, and analysis of covariance were used for comparing the two groups. Results: The levels of liver enzymes, weight, and waist circumference decreased in both groups. The mean reduction in alanine transaminase (ALT) in the intervention group was 22.80, while it was 1.59 in the placebo group (P = 0.008). The mean weight loss in the intervention and placebo groups was 2.69 kg and 0.9 kg, respectively (P = 0.003). Moreover, the mean reduction in waist circumference in the intervention and placebo groups was 3.43 cm and 0.33 cm, respectively (P = 0.001). Conclusions: Dava Al-Balgham tablets with the weight loss and hypolipidemic effect of its components can be used to help the prevention and treatment of NAFLD.

Effect of an Herbal Product on the Serum Level of Liver Enzymes in Patients with Non-Alcoholic Fatty Liver Disease: A Randomized, Double-Blinded, Placebo-Controlled Trial

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in children. With increasing prevalence of childhood obesity, NAFLD is increasingly seen in children. The prevalence varies according to the population studied (race and ethnicity) and the definition of NAFLD used in the study. In Iran, the prevalence of NAFLD in obese children ranges from 50% to 55% and in the general population of children is about 17%. Most patients with NAFLD are asymptomatic. However, abdominal pain may be present in the right and upper extremity, and hepatomegaly or non-specific symptoms such as abdominal discomfort, weakness, fatigue or attention disorder may also be seen. Diagnostic methods of NAFLD include laboratory tests, biomarkers, biopsy, and imaging studies such as ultrasound, CT, MRI. There is no definitive treatment for non-alcoholic liver disease. Modification of some risk factors such as obesity, diabetes, and hyperlipidemia are often recommended, but weight loss is more beneficial. Early diagnosis of NAFLD in children and its management can reduce further complications. Therefore, in this study, we reviewed the articles published on NAFLD in children (until 2017) using electronic databases, including PubMed, ProQuest, Scopus, and Google Scholar. We reviewed the signs of NAFLD, its epidemiology, etiology, complications, laboratory findings, different diagnostic methods, treatments, and follow up procedures.

Non-alcoholic Fatty Liver Disease in Children

Purpose: The identification of significant fibrosis is critical for predicting the prognosis of non-alcoholic fatty liver disease (NAFLD). This study aimed to compare the predictive value of chitinase-3-like protein 1 (CHl3L1) and other non-invasive biomarkers, as well as to establish a novel non-invasive diagnostic model for assessing the risk of significant fibrosis in NAFLD. Patients and Methods: A total of 71 patients with confirmed NAFLD based on liver biopsy were included in this study. Serum CHI3L1 levels and other non-invasive fibrosis assessment measures were determined. The aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 Index (FIB-4) were calculated to assess the diagnostic superiority of serum CHI3L1 compared to other non-invasive fibrosis assessment measures. Multivariate logistic regression analysis was conducted to identify relevant variables for constructing a diagnostic model. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of each index, including the area under ROC curve (AUC), sensitivity, and specificity. A nomogram was established based on the logistic regression model. Results: Serum CHI3LI levels were found to be higher in NAFLD patients with significant fibrosis compared to those without significant fibrosis. Multivariate logistic regression analysis revealed that aspartate aminotransferase (AST), type IV collagen (IV-C), CHI3L1, and liver stiffness measurement (LSM) were identified as potential independent risk factors associated with significant fibrosis in patients. The AUC of CHI3L1 for diagnosing significant liver fibrosis was 0.716 (0.596,0.836), with the optimal cut-off point of 125.315. The nomogram incorporating CHI3LI, AST, IV-C, and LSM further improved the potential predictive value, with an AUC for diagnosing significant fibrosis of 0.864 (0.766,0.962). This was superior to IV-C, CHI3L1, LSM, and APRI (all p < 0.05). Conclusion: The diagnostic model constructed by CHI3L1 combined with the existing non-invasive markers AST, IV-C, and LSM can help assess the risk of significant liver fibrosis in NAFLD. Keywords: nonalcoholic fatty liver disease, fibrosis, chitinase 3-like protein 1, liver biopsy, nomogram 

Association of Non-Invasive Markers with Significant Fibrosis in Patients with Nonalcoholic Fatty Liver Disease: A Cross-Sectional Study

Introduction: Nonalcoholic fatty liver disease (NAFLD) is raising prevalence among children, and adolescence population in developed and developing countries as a major public health concern. The present study aims to determine the relationship between serum ferritin level and transient elastography findings in patients suffering from NAFLD. Materials and Methods: The demographic and biochemical profile of included individuals such as body mass index, age, level of serum transaminases, fasting blood sugar, lipid profile, and serum ferritin level were determined and a transient elastography was performed for all of them. Results: The mean serum ferritin level among men with mild and advanced liver stiffness was 154 ± 97 and 244 ± 214, respectively (P

Relationship between serum ferritin level and transient elastography findings among patients with nonalcoholic fatty liver disease

The presence of increased air bubble in the lumina of esophagus on a chest CT scan may be associated with esophageal disorders. The purpose of this study was to determine the association between the appearance of air bubbles on chest CT scan and gastroesophageal Reflux Disease (GERD). In this case-control study, thirty-two patients with endoscopically proved GERD and 32 subjects without GERD underwent chest computed tomography (CT) scanning. Esophageal dilatation (ED) was defined as the presence of air bubbles greater than 10 mm in the supra ventricle (SV) and ventricle (CV), and air bubbles >15 mm in the ventricle to the lower esophageal sphincter (V-LES). The results were compared between the two groups. The GERD patients included 16 (50%) males with a mean age of 58.5±11.2 years and the control group included 17 (54.8%) males and 14 (45.1%) females with a mean age of 66.7±10.5 years. There was a significant relationship between the presence of GERD and esophageal dilation (ED) in the V-LES sections on the CT scan (P=0.002). The mean size of the air bubbles in the V-LES section was 11.73 mm in the case group in comparison to 4.32 mm in the control group (P<0.001).  The size and location of the air bubbles in the esophagus can vary and be important. The possibility of GERD increases in the presence of esophageal dilation on CT scan.

/pdf/association-of-esophageal-dilatation-in-chest-ct-scan-with-5ek5i7uer8.pdf

Association of esophageal dilatation in chest CT scan with gastroesophageal reflux disease: A case control study.

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Relationship between serum ferritin level and transient elastography findings among patients with nonalcoholic fatty liver disease

Association of esophageal dilatation in chest CT scan with gastroesophageal reflux disease: A case control study.