Early predictors of liver injury in patients on parenteral nutrition.

BACKGROUND: Parenteral nutrition-associated liver disease (PNALD) is diagnosed after at least 2 weeks of total parenteral nutrition (PN). However, its symptoms may occur early during PN. The aim of this study was to determine the early biochemical predictors of PNALD. METHODS: This cross-sectional retrospective study included 160 patients on total parenteral nutrition. The clinical and laboratory data collected during parenteral nutrition were analyzed. Patients were assessed before the onset, on the 2nd, 7th and on the 14th day of PN according to the definition of PNALD and in search for predominant liver function tests findings. RESULTS: Out of 160 patients, 21 fulfilled the laboratory criteria of PNALD on the 14th day of PN. In the group of patients with PNALD, 14 met these criteria on the 7th day of PN. In multivariate logistic analyses the laboratory criteria of PNALD met on the 7th day of PN (OR = 5637; 95%Cl: 1.162-33.578; p-value = .039) were found to be of predictive value for PNALD on the 14th day. In PNALD group the 1.5-fold elevation of GGTP activity above upper limit of norm was the most prominent laboratory finding during the fourteen-day course of PN. The percentage of patients with 1.5-fold increased activity of GGTP varied in time from 76.2% to 95.2% on the 2nd and 14th day of PN, respectively. CONCLUSION: PNALD may be predicted by liver function monitoring after seven days of PN.

Eosinophilic esophagitis: an interdisciplinary clinical problem.

Eosinophilic esophagitis is a newly described entity of increasing incidence. Previously thought to be a variation of gastroesophageal reflux disease, now it becomes well known among gastroenterologists, allergologists, paediatricians and pathologists. Aetiology of the disease is strongly correlated with atopic and allergic disorders but exact pathogenesis and cellular mechanisms of inflammatory process in the esophagus are still unknown. Diagnostic criteria have been described but diagnostic tools are still in the research and improvement phase. Clinical manifestation varies considerably between age groups, which causes a delay in the course of diagnosis due to improperly recognized symptoms. Since eosinophilic esophagitis is a chronic disease without a tendency to be self-limiting, delayed diagnosis may lead to complications associated with oesophageal tissue remodelling. Some forms of treatment are approved and of great therapeutical value, nevertheless clinical trials of new medications provide new possibilities. Therefore, many questions regarding eosinophilic esophagitis arise and are still unanswered.

Review of parenteral nutrition-associated liver disease.

Parenteral nutrition has been widely used in patients whose gastrointestinal tract is anatomically or physiologically unavailable for sufficient food intake. It has been considered lifesaving but is not without adverse effects. It has been proven to cause liver injury through different mechanisms. We present a review of parenteral nutrition-associated liver disease.