Annals of Gastroenterology & Hepatology Vol I Issue 1

Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)‐Induced Liver Failure

Arylraj R, Webb K, Neuberger J:  Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)-Induced Liver Failure.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  91-100

Review Article

Outcomes of Liver Transplantation for Acetaminophen (Paracetamol)‐Induced Liver Failure

Ramakrishnan Arulraj^1, Kerry Webb^1,2 and James Neuberger^1,3

Affiliations: ¹Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; ²Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK and ³Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK


ABSTRACT

Liver damage from acetaminophen toxicity, whether as a result of a deliberate attempt at self‐harm or as a consequence of therapeutic misadventure, may, if not promptly treated, lead to liver failure and, in the absence of transplantation, to death. Risk factors for the development of liver failure include primarily the amount ingested and time to treatment, but use of alcohol, either before or with the ingestion, age, nutritional state, and concomitant therapy are also implicated. Many of those who take an overdose have a history of previous deliberate self‐harm, previous psychiatric illness, substance abuse, and a poor social and employment background. Once liver failure has developed, treatment is supportive but, for some, liver transplantation remains the only therapeutic option, and the use of liver support devices and dialysis remains for the future. Criteria for transplantation in this setting are now well documented. However, because of the shortage of donors, there remain concerns about the optimal use of this scarce resource. Thus, as well as establishing the need for a transplant in the small space of time between presentation and the onset of irreversible complications that would render a transplant futile, the clinical team will need to make extensive enquiries from the patient (where possible), the family, and the clinical support team. Where transplant is considered, the team will need to ensure that there is a good likelihood of compliance with treatment and follow‐up, and there will be in place a robust support package to prevent further attempts at self‐harm. However, current data show that, at least in the medium term, good outcomes can be obtained, although there is a risk of further attempts at self‐harm and of non‐compliance. Although most centers use orthotopic liver transplants, good outcomes have been obtained with auxiliary grafts, which allow for withdrawal of immunosuppression where the native liver recovers.

Keywords: Paracetamol, Acetaminophen, Liver failure, transplantation, outcome
Correspondence: James Neuberger, Organ Donation and Transplantation, NHS Blood and Transplant, Fox Den Road, Bristol, BS34 8RR, UK. e‐mail: James.Neuberger@nhsbt.nhs.uk

Predicting Neoplastic Progression in Barrett's Esophagus

Predicting Susceptibility to Celiac Disease by Genetic Risk Profiling

Romanos J, Wijmenga C; Predicting Susceptibility to Celiac Disease by Genetic Risk Profiling. Annals of Gastroenterology & Hepatology., June 2010; 1(1):  11-18

Review Article

Predicting Susceptibility to Celiac Disease by Genetic Risk Profiling

Jihane Romanos and Cisca Wijmenga

Affiliation: ¹Department of Genetics, University Medical Center Groningen, University of Groningen


ABSTRACT

Celiac disease (CD) is a common, immune‐mediated, intestinal disorder with a prevalence of approximately 1% in Caucasians. An important and necessary genetic risk factor is HLA‐DQ2. Dietary gluten is the triggering environmental factor, and a lifelong gluten‐free diet is currently the only treatment for CD. CD is officially diagnosed by serology followed by a small intestinal biopsy. However, the majority of CD patients go undiagnosed as the symptoms associated with CD can be rather subtle, and many patients remain at a silent or latent stage. As CD is associated with increased morbidity and mortality, it puts a severe socio‐economic burden on patients, their families, and society. Improved diagnosis of CD and early intervention would alleviate, or reverse, these negative effects. The recent identification of part of the genetic risk for CD may help in diagnosing individuals at high risk for CD before the disease manifests. In this review, we show how genetic knowledge can be applied as a diagnostic or screening tool to prevent comorbidity and long‐term complications. We envision a two‐step approach. First, based on human leukocyte antigen (HLA) typing, we can exclude individuals with no HLA‐DQ2/DQ8 as they have no risk of developing CD. Second, we can combine the presence of HLA‐DQ2/DQ8 with the non‐HLA genetic risk factors and classify the remaining individuals into low (<0.1%), intermediate (0.1–7%), and high (>7%) risk groups. Individuals in both the intermediate‐ and high‐risk groups should undergo serology and biopsy testing. Our prediction model for CD will lead to improved diagnostic and prevention strategies.

Keywords: celiac disease, genetic profile, predictive test, human leukocyte antigen (HLA), gluten intolerance, gluten sensitive enteropathy, celiac sprue

Correspondence: Cisca Wijmenga, Department of Genetics, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands. Tel: (31)‐(0)50‐361‐7100; Fax: (31)‐(0)50‐361‐7230; e‐mail: c.wijmenga@medgen.umcg.nl

Acne and Inflammatory Bowel Disease: Insights from SAPHO and PAPA Syndromes?

Bloating and Distension in Irritable Bowel Syndrome: Recent Advances, Speculations, and Possible Implications for Future Treatment

The Effect of Placebo in Irritable Bowel Syndrome and Functional Constipation in Children: A Systematic Review

Autoimmune Hemolytic Anemia associated with Ulcerative Colitis

Leo E, Trigo C, Herrera JM, Marquez JL:  Autoimmune Hemolytic Anemia Associated with Ulcerative Colitis.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  45-49

Review Article


Eduardo Leo, Claudio Trigo, José M Herrera and José L Márquez

Affiliations: ¹Department of Gastroenterology, University Hospital Virgen del Rocío


ABSTRACT

Although anemia is very common in patients with ulcerative colitis, its association with autoimmune hemolytic anemia is infrequent. This is a review of the cases reported to date, with an analysis of the underlying physiopathological mechanisms. In this context, it is suggested that the inflammatory alterations at colon level act as an antigenic stimulant, resulting in the formation of antibodies exhibiting cross‐reactivity with the erythrocytes, although other theories have also been proposed. Drugs destined to modulate the immune system are the treatment of choice when both conditions coexist, involving a step‐up regimen starting with steroids. For years, surgery has been advocated as rescue treatment in the case of steroid failure, although the introduction of new immunosuppressor drugs and biological agents now offers new alternatives.

Keywords: ulcerative colitis, autoimmune hemolytic anemia, Coombs’ test

Correspondence: Eduardo Leo, Department of Gastroenterology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n. 41013, Seville, Spain. Tel: (34)‐955‐01‐22‐51; e‐mail: eleoc@telefonica.net

Estimation of Short‐Term Prognosis in Advanced Liver Disease

Stauber RE:  Estimation of Short-Term Prognosis in Advanced Liver Disease.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  51-54

Review Article

Estimation of Short‐Term Prognosis in Advanced Liver Disease

Rudolf E Stauber



Affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria


ABSTRACT

Short‐term prognosis in advanced liver disease may be estimated by liver‐specific prognostic models, such as the Child–Pugh score, the model for end‐stage liver disease (MELD) score and Na‐containing models, or by general intensive care unit (ICU) prognostic models such as the acute physiology and chronic health evaluation (APACHE) scores and the sequential organ failure assessment (SOFA) score. The general ICU prognostic models proved superior to the liver‐specific models in critically ill cirrhotic patients admitted to the ICU. Indocyanine green clearance was proposed as a quantitative liver function test several decades ago and may now be measured non‐invasively by finger‐pulse densitometry; however, its diagnostic accuracy was found to be inferior to that of MELD in decompensated cirrhosis.

Keywords: chronic liver failure, acute‐on‐chronic liver failure, decompensated cirrhosis, liver transplantation, Child–Pugh score, MELD score, SOFA score, APACHE II score, APACHE III score

Correspondence: Rudolf E Stauber, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A‐8036 Graz, Austria. Tel: (43)‐316‐385‐80268; Fax: (43)‐316‐385‐2648; e‐mail: rudolf.stauber@medunigraz.at

Screening and Surveillance of Individuals at High Risk for Pancreatic Cancer: Where are We now?

Harinck F, Poley JW, Bruno MJ:  Screening and Surveillance of Individuals at High Risk for Pancreatic Cancer:  Where are We now?  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  55-62

Review Article

Screening and Surveillance of Individuals at High Risk for Pancreatic Cancer: Where are We now?

Femme Harinck, Jan‐Werner Poley and Marco J Bruno


Affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands


ABSTRACT

Pancreatic cancer (PC) is one of the most fatal of all malignancies. The median survival after diagnosis is 6 months. The overall 5‐year survival is less than 5%. Despite improvements in imaging and surgical techniques, survival statistics have hardly improved over the past decades. Resection offers the only chance for cure, but due to early vascular involvement and/or metastatic spread, only a minority (10–20%) of symptomatic patients are eligible for surgery. Sadly, even after resection, the outcome in these patients is disappointingly low with a 5‐year survival of only 10–30%. Consequently, to improve this dismal outlook, it would be desirable to detect small asymptomatic early cancers or, more preferably, precursor lesions at the time when the disease is still at a curable stage. Well‐defined precursor lesions of pancreatic cancer include pancreatic intraepithelial neoplasm (PanIN) and intraductal papillary mucinous neoplasia (IPMN). Detection and resection of these lesions before they turn malignant might improve survival. Because of the relatively low incidence of the disease and the lack of accurate, inexpensive, and non‐invasive diagnostic tests for detection, screening of the general population is not realistic. However, screening might be feasible in a well‐defined population of individuals at high risk for this fatal disease. Here, we summarize the current status of pancreatic cancer screening and surveillance in high‐risk individuals.

Keywords: familial pancreatic cancer, pancreatic cancer susceptibility, surveillance and screening

Correspondence: Jan‐Werner Poley, Erasmus MC, University Medical Center Rotterdam, Department of Gastroentreology and Hepatology, ’s Gravendijkwal 230, CE Rotterdam, the Netherlands. Tel: (31)‐10‐70‐3015; Fax: (31)‐10‐703‐4682; e‐mail: j.poley@erasmusmc.nl

Liver Transplantation Costs for End‐Stage Liver Disease

Salvalaggio PR, Cantafio A, Montenovo MI:  Liver Transplantation Cost for End-Stage Liver Disease.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  71-77

Review Article

Liver Transplantation Costs for End‐Stage Liver Disease

Paolo R Salvalaggio, Alex Cantafio and Martin I Montenovo

Affiliation:  Department of Surgery, University of Washington, Seattle, WA


ABSTRACT

Liver transplantation is the treatment of choice for patients with end‐stage liver disease. The estimated annual cost of liver transplantation in the United States exceeds 1 billion dollars. The costs of liver transplantation are impacted by the severity of liver disease, comorbidities of the recipient, donor and transplant center factors. The implementation of the MELD score in organ allocation and the utilization of donors of low quality have contributed to a recent increase in resource consumption after liver transplantation. Present utilization of transplant registries without cost information makes difficult the study of the costs of liver transplantation. To permit clear understanding of the costs in liver transplantation and advance the field with concomitant cost reduction, the transplant community must investigate the impact of outliers in the cost of liver transplantation, design better clinical tools to better match donors and recipients, understand how resources are consumed by patients with high MELD scores, and focus in better contracting.

Keywords: liver transplantation, cost, reimbursement, model for end‐stage liver disease (MELD), donor risk index (DRG)

Correspondence: Paolo R Salvalaggio, Division of Transplant Surgery, Department of Surgery, University of Washington, UWMC Box 356410, 1959 NE Pacific St EE 412, Seattle, WA 98195, USA. Tel: (1)‐206‐598‐6263; Fax: (1)‐206‐598‐7449; e‐mail: psalvala@u.washington.edu

Recurrent Autoimmune Hepatitis After Liver Transplantation

Czaja AJ:  Recurrent Autoimmune Hepatitis After Liver Transplantation.  Annals of Gastroenterology & Hepatology., June 2010; 1(1):  79-89

Review Article

Recurrent Autoimmune Hepatitis After Liver Transplantation

Albert J. Czaja

Affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA


ABSTRACT

Background: Autoimmune hepatitis recurs after liver transplantation, but its recognition may be difficult because of immunosuppressive therapy and other superimposed conditions.

Aims: To review the nature, mechanisms, and treatment of recurrent autoimmune hepatitis, and to facilitate its prompt recognition and effective therapy.

Methods: Prime source and review articles in English were selected through MedLine from 1984 to 2009 and assimilated into personal libraries spanning this same interval.

Results: Autoimmune hepatitis recurs after liver transplantation in 12–46% of patients, and it usually develops 1–8 years after the procedure (median 2 years). The frequency increases from 12% at 1 year to 36% after 5 years, and progression to cirrhosis and graft failure is possible. Asymptomatic histological recurrence may precede clinical recurrence by 1–5 years, but its impact on prognosis is uncertain. The diagnostic requirements are the same as for native disease, but the findings may be less pronounced, and the exclusion of acute and chronic cellular rejection is essential. The risk of recurrence relates to the elapsed time after transplantation, frequency of acute and chronic rejection, and adjustments in the immunosuppressive regimen. Genetic predispositions of the patient and severity of the original disease may also contribute. Graft and patient survival ranges from 78% to 89%, and the disease usually responds to adjustments in the immunosuppressive regimen or the reintroduction of corticosteroids. Refractory disease may require other medication (another calcineurin inhibitor or rapamycin) or retransplantation.

Conclusions: Recurrent autoimmune hepatitis is common, potentially aggressive, but usually managed successfully.

Keywords: recurrence, transplantation, autoimmune hepatitis, treatment

Correspondence: Albert J Czaja, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota 55905, USA. Tel: (1)‐507‐284‐8118; Fax: (1)‐507‐284‐0538; e‐mail: czaja.albert@mayo.edu

Microsurgical Techniques for Researching Liver Diseases: A Review