Acta Gastro-enterologica Belgica 

About: Acta Gastro-enterologica Belgica is an academic journal. The journal publishes majorly in the area(s): Cancer & Pancreatitis. It has an ISSN identifier of 0001-5644. Over the lifetime, 6538 publications have been published receiving 20297 citations.

Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome: a pilot study.

Abstract: Background : Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis. Recently, ornipressin, a potent splanchnic vasoconstrictor, was reported to improve renal function in patients with HRS. However, this treatment is associated with a high incidence of vascular complications. Terlipressin is thought to be as effective as ornipressin with less systemic complications. Aims : To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type 1 HRS. Patients : Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club were included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3,4 mg% {2,5-4,0} ; 127 mEq/l {124-130}, 500 ml/24h {100-1031} and 7 mEq/24h {1-17}. Methods : Terlipressin was administered iv 2 mg bid in 8 patients and tid in 4 others for at least one week and up to 2 months. Results : After one week of treatment median plasma creatinine decreased to 1.8 mg% {1.3-2.1} together with an increase in urine volume, sodium excretion, creatinine and free-water clearance. Three patients underwent successful liver transplantation with a near normal renal function after 34, 36 and 111 days. The 9 other patients died during follow-up (4 from sepsis, 2 from digestive bleeding and 3 from liver failure). No ischaemic complications were encountered during the treatment. Conclusions : Long-term terlipressin administration is safe and effective to control type 1 HRS. However, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.

Effects of sitagliptin in diabetic patients with nonalcoholic steatohepatitis.

Abstract: BACKGROUND & AIMS Preliminary evidence suggests that inhibition of dipeptidyl peptidase (DPP)-IV preserves pancreatic beta cell function in patients with type 2 diabetes (T2D). However, its effects on liver histology in nonalcoholic steatohepatitis (NASH), hepatic complication of diabetes, have not yet been adequately explored. The present open-label, single-arm observational pilot study investigated the effects of one year of treatment with a dipeptidyl peptidase-IV inhibitor, sitagliptin, on liver histology, body mass index (BMI), and laboratory parameters in NASH patients with T2D. PATIENTS AND METHODS Paired liver biopsies from 15 diabetic patients with NASH (7 males, 8 females; mean age: 49.7 +/- 8.1 years (range: 36-62)) before and after one year of therapy with sitagliptin 100 mg once daily were studied. Clinical and laboratory parameters were recorded. RESULTS Treatment with sitagliptin resulted in a significant decrease in ballooning (P = 0.014) and NASH scores (P = 0.04), while the reduction in the steatosis score was of borderline statistical significance (P = 0.054). These effects were accompanied by a significant reduction in body mass index, AST, and ALT levels. CONCLUSION Our study suggests that sitagliptin ameliorates liver enzymes and hepatocyte ballooning in NASH patients with T2D and may have therapeutic implications.

Lean non-alcoholic fatty liver disease (Lean-NAFLD): a major cause of cryptogenic liver disease.

Abstract: AIMS Non-alcoholic fatty liver disease (NAFLD) is strongly associated to obesity and type 2 diabetes, but may occur in the absence of these factors. Based on a large series of liver biopsies, we have evaluated the clinical, biochemical, metabolic and pathological characteristics of a new entity, which we refer to as "lean-NAFLD". METHODS Among 1,777 patients, who underwent liver biopsy for chronic liver disease, Lean-NAFLD, defined as patients with NAFLD without obesity (BMI < 30 kg/m2) and without diabetes was found in 50 of them (2.8%), being the most frequent cause (38%) of cryptogenic liver disease. Thirty-one patients from the Lean-NAFLD group were compared to 48 Obese-NAFLD patients diagnosed during the same period and 8 healthy control patients. Insulin resistance was determined using the homeostasis model assessment method. RESULTS In the Lean-NAFLD group as compared to the obese-NAFLD group, patients were younger : median 40 vs. 49 years, p = 0.047, with male predominance: 71 vs. 46%, p = 0.037. Fasting glucose and HbA1c were lower, as was insulin sensitivity: 1.7 vs. 3.0, p = 0.049. Blood pressure was significantly lower (p = 0.001) while triglycerides and HDL-cholesterol were similar. Although there was less inflammation (p = 0.038) and fibrosis (p = 0.029), non-alcoholic steatohepatitis and fibrosis were present in 61% and 55% of the Lean-NAFLD group, respectively. Compared to healthy controls, Lean-NAFLD were less insulin sensitive, with a insulin sensitivity index of 59 vs. 110 (p = 0.015), and more hypertriglyceridemic (p = 0.003). CONCLUSIONS Lean-NAFLD is a new unrecognized clinicopathological entity, a frequent cause of cryptogenic liver disease.