Subject(s)
Ribavirin , Sustained Virologic Response , Antiviral Agents , Hepacivirus , Hepatitis C , Hepatitis C, Chronic , Humans , Lymphoma , Treatment OutcomeABSTRACT
BACKGROUND AND STUDY AIMS: Upper gastrointestinal endoscopy (UGE) is currently recommended in cirrhotic patients to detect the presence of esophageal varices (EV). Spleen stiffness measurement (SSM) with FibroScan has been used for this purpose, showing variable sensitivity (S) and specificity (Sp). The aim of this study was to evaluate the capability of SSM to detect the presence and size of EV in cirrhotic patients in comparison to other noninvasive modalities. PATIENTS AND METHODS: Sixty-six patients with cirrhosis who had undergone UGE in the previous 6 months underwent SSM and liver stiffness measurement (LSM) using FibroScan. Biochemical parameters and ultrasonography data were also collected to calculate other noninvasive indexes. RESULTS: Valid spleen stiffness measurements were obtained for 60 of the 66 patients initially included in the study (90.1%). In the multivariate analysis only splenomegaly and SSM were predictive of esophageal varices. SSM was the most accurate diagnostic tool, obtaining an area under the ROC curve of 0.8 for values below 48 KPascals, with S = 87%, Sp = 69%, and 76.7% of successfully diagnosed patients. CONCLUSIONS: SSM with FibroScan was significantly higher for cirrhotic patients with EV. Our study suggests that spleen stiffness may be useful to identify cirrhotic patients at risk of having EV, although further studies are needed.
Subject(s)
Elasticity Imaging Techniques/methods , Esophageal and Gastric Varices/diagnostic imaging , Liver Cirrhosis/complications , Liver Cirrhosis/diagnostic imaging , Spleen/diagnostic imaging , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/pathology , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology , Predictive Value of Tests , ROC Curve , Sensitivity and SpecificityABSTRACT
Actualmente, la anemia perniciosa es la causa más frecuente de déficit de vitamina B12 en los países occidentales. La lesión histológica sobre la que se sustenta es la gastritis crónica atrófica autoinmune. La destrucción de las células parietales provoca un déficit de factor intrínseco, proteína fundamental para que la vitamina B12 se absorba en el íleon terminal. Los avances que se han producido en las dos últimas décadas han reabierto el debate sobre una enfermedad que parecía olvidada por su aparente simplicidad. El nuevo papel del H. pylori, el valor de los anticuerpos anticélula parietal y antifactor intrínseco, la verdadera utilidad de los niveles séricos de vitamina B12, el riesgo de adenocarcinoma y carcinoides gástricos o el tratamiento con vitamina B12 oral, son algunos de los temas de actualidad que se analizan en profundidad en esta revisión (AU)
Pernicious anemia is currently the most common cause of vitamin B12 deficiency in Western countries. The histological lesion upon which this condition is based is autoimmune chronic atrophic gastritis. The destruction of parietal cells causes a deficiency in intrinsic factor, an essential protein for vitamin B12 absorption in the terminal ileum. Advances in the last two decades have reopened the debate on a disease that seemed to have been forgotten due to its apparent simplicity. The new role of H. pylori, the value of parietal cell antibodies and intrinsic factor antibodies, the true usefulness of serum vitamin B12 levels, the risk of adenocarcinoma and gastric carcinoids and oral vitamin B12 treatment are just some of the current issues analyzed in depth in this review (AU)
Subject(s)
Adult , Humans , Male , Anemia, Pernicious/physiopathology , Vitamin B 12 Deficiency/physiopathology , Helicobacter Infections/physiopathology , Stomach Neoplasms/epidemiology , Intrinsic Factor/deficiency , Helicobacter pylori/pathogenicity , Parietal Cells, Gastric/immunology , Homocysteine/immunology , Methylmalonic Acid/immunology , Vitamin B 12/therapeutic use , Adenocarcinoma/prevention & controlABSTRACT
Pernicious anemia is currently the most common cause of vitamin B12 deficiency in Western countries. The histological lesion upon which this condition is based is autoimmune chronic atrophic gastritis. The destruction of parietal cells causes a deficiency in intrinsic factor, an essential protein for vitamin B12 absorption in the terminal ileum. Advances in the last two decades have reopened the debate on a disease that seemed to have been forgotten due to its apparent simplicity. The new role of H. pylori, the value of parietal cell antibodies and intrinsic factor antibodies, the true usefulness of serum vitamin B12 levels, the risk of adenocarcinoma and gastric carcinoids and oral vitamin B12 treatment are just some of the current issues analyzed in depth in this review.
