https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.25762

The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

SUMMARY Background Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease, and its worldwide prevalence continues to increase with the growing obesity epidemic. This study assesses the epidemiology of NAFLD in adults based on clinical literature published over the past 30 years. Aim To review epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults based on clinical literature published over the past 30 years. Methods An in-depth search of PubMed (1980–2010) was based on five search terms: ‘nonalcoholic fatty liver disease’ OR ‘non-alcoholic steatohepatitis’ OR ‘fatty liver’ OR ‘steatosis’ AND ‘incidence’ [MeSH Terms] OR ‘prevalence’ [MeSH Terms] OR ‘natural history’. Studies of paediatric cohorts were excluded. Articles were categorised by topic and summarised, noting generalisations concerning their content.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2036.2011.04724.x

Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults.

Background Sclerosing pancreatitis is a unique form of pancreatitis that is characterized by irregular narrowing of the main pancreatic duct, lymphoplasmacytic inflammation of the pancreas, and hypergammaglobulinemia and that responds to glucocorticoid treatment. Preliminary studies suggested that serum IgG4 concentrations are elevated in this disease but not in other diseases of the pancreas or biliary tract. Methods We measured serum IgG4 concentrations using single radial immunodiffusion and an enzyme-linked immunosorbent assay in 20 patients with sclerosing pancreatitis, 20 age- and sex-matched normal subjects, and 154 patients with pancreatic cancer, ordinary chronic pancreatitis, primary biliary cirrhosis, primary sclerosing cholangitis, or Sjogren's syndrome. Serum concentrations of immune complexes and the IgG4 subclass of immune complexes were determined by means of an enzyme-linked immunosorbent assay with monoclonal rheumatoid factor. Results The median serum IgG4 concentration in the patients ...

https://www.nejm.org/doi/pdf/10.1056/NEJM200103083441005

High serum IgG4 concentrations in patients with sclerosing pancreatitis.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.20973

Nonalcoholic fatty liver disease: From steatosis to cirrhosis

/pdf/nccn-clinical-practice-guidelines-in-oncology-hepatobiliary-1kpacqqvi8.pdf

NCCN clinical practice guidelines in oncology: hepatobiliary cancers.

Autoimmune pancreatitis (AIP) is a peculiar form of pancreatitis that has been known for the last two decades. Sarles et al. [1] first reported pancreatitis associated with hypergammaglobulinemia in 1961. They suggested that autoimmunity was one of the etiologies of pancreatitis. The first case that led researchers to suggest a new concept of autoimmune pancreatitis (AIP) was treated with steroids by gastroenterologists (led by Professor Tadashi Takeuchi) in Tokyo Medical Women’s University, and the concept was proposed by Yoshida, a member of that group, in 1995 [2]. The characteristic histological feature of the AIP is lymphoplasmacytic sclerosing pancreatitis (LPSP) [3]. AIP has been increasingly seen over the last decade and is now considered a distinct entity [4, 5]. Based on histological and immunohistochemical examinations of various organs and extrapancreatic lesions of AIP patients, a new clinicopathological entity called “IgG4-related systemic disease” was proposed [4, 6]. AIP is now considered to be a pancreatic manifestation of IgG4-related disease [4, 5, 7].

Overview of Type 1 and Type 2 AIP

We assessed the clinicopathological features of nonalcoholic fatty liver disease (NAFLD) in patients stratified by the stage of fibrosis One-hundred and ninety-three patients were diagnosed as having NAFLD at Tokyo Women’s Medical University or an affiliated hospital, from 1990 to September 2003, and their clinical data were collected prospectively The diagnosis of NAFLD was based on the following criteria: (1) the presence of steatosis (affecting >30% of hepatocytes) or steatohepatitis, with steatohepatitis being defined by detection of steatosis (affecting >10% of hepatocytes), inflammatory infiltrates, and ballooning degeneration with or without Mallory bodies, pericellular fibrosis, and perivenular fibrosis; (2) intake of less than 20g of ethanol per week; and (3) appropriate exclusion of other liver diseases We assessed the clinicopathological features of NAFLD in patients stratified by the stage of fibrosis The median age of the patients was 53 years, with a range of 10 to 83 years There were 96 males and 97 females Eighty-five percent of the patients had at least one of the features of the metabolic syndrome Histologically, 29 patients had established cirrhosis In regard to severe fibrosis, females and older patients were more common There were correlations between serum hyaluronic acid level, type IV collagen level, or platelet count and the stage of fibrosis Eight patients developed hepatocellular carcinoma Except for 1 F3 patient, they all had cirrhosis Liver biopsy is invasive, expensive, and not suitable for all NALFD patients Because we found correlations between serum fibrosis markers, or platelet count and the stage of fibrosis, these markers may be useful to identify NASH with severe fibrosis among NAFLD patients

Clinical Features of Patients with Nonalcoholic Fatty Liver Disease

（目的）IFN, Ribavirin併用療法の効果予測は，今だ不明な点が多い．今回，ウイルスが一度も消失しなかった無効例の遺伝子多型等の関与について検討した． （対象）C型慢性肝炎患者でIFNα+Ribavirinを投与した66例を対象とした．IFNの効果は，持続消失（SR）32例，一過性消失（TR）16例，HCV消失せず（NR）18例で，TNF-α, TNF-β, IL10, MxA遺伝子の多型性部位に関して検索した． （結果）Serotype 2型がNR例で有意に少ないが，ウイルス量は差を認めなかった．生体側因子として，F3以上の高度線維化群の割合がNR例に多かった．遺伝子多型に関しては，TNF-β genotypeのB2/B2保有率がNR例に多かった． （結論）IFN, Ribavirin併用療法の無効例では，Serotype，肝線維化，TNF-β遺伝子多型などが関与している可能性が示唆された．

Analysis including gene polymorphism in non-responder to interferon and ribavirin combined therapy

Five cases of gastric bezoar study in our hospital

ESWL+内視鏡は膵石治療の第一選択として定着し，高い除痛率を中心に良好な成績が報告されている．この18年間に当院で経験した膵石症は237例で，有症状225例に治療を行なった．その内の214例に内科的治療（ESWL and/or内視鏡治療）を行ない，排石率は72%,除痛率は97%,結石再発率10%，内外分泌能改善はそれぞれ32%,33%であった．体部狭窄膵管の尾側に結石を有した有症状例9例は外科手術を行なった．仮性嚢胞·膿瘍合併は49例で，経皮的ドレナージ·ESWL·内視鏡で治療した．また仮性動脈瘤合併は5例であった．膵管狭窄を解除し結石再発を防止する方策として，1996年より内視鏡的膵管バルーン拡張術（EPDBD；Endoscopic Pancreatic Duct Balloon Dilation）を118例で行ない良好な結果を得た．またこの5年間に副乳頭経由の排石治療を31例で行ない，Wirsung管狭窄例等で良好な結果を得た．経過観察中の死亡例は16例で，膵癌2，肺癌2，咽頭癌1，食道癌1，大腸癌1，急性アルコール中毒1，多病死8で，排石治療後も膵癌のみならず消化管·呼吸器·耳鼻科領域の発癌を念頭におく必要がある．

Keiko Shiratori

Papers

Overview of Type 1 and Type 2 AIP

Clinical Features of Patients with Nonalcoholic Fatty Liver Disease

Analysis including gene polymorphism in non-responder to interferon and ribavirin combined therapy

Five cases of gastric bezoar study in our hospital

Treatment of 225 Cases of Chronic Pancreatitis and Pancreatic Stones: ― The Effect of ESWL+Endoscopy Therapy and Its Prognosis ―