Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future mana...Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.展开更多
Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic ba...Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria (i.e., gram negative species) and a decrease in autochthonous familiae. Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences. We therefore described the features of the complex interaction between gut microbiota and cirrhotic host, the so called “gut-liver axis”, with a particular attention to the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections in the cirrhotic patient. Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis.展开更多
AIM： To explore the relationship between changes of intestinal environment and pathogenesis of non-alcoholic steatohepatitis （NASH）. METHODS： Forty-two Sprague-Dawley rats were randomly dMded into model group （n ...AIM： To explore the relationship between changes of intestinal environment and pathogenesis of non-alcoholic steatohepatitis （NASH）. METHODS： Forty-two Sprague-Dawley rats were randomly dMded into model group （n = 24）, treatment group （n = 12）, and control group （n = 6）. The rats of model and treatment groups were given high-fat diet, and those of the control group were given normal diet. Furthermore, the rats of treatment group were given lactulose after 8 wk of high-fat diet. Twelve rats of the model group were killed at 8 wk of high-fat diet. At the 16 wk the rats of treatment group, control group, and the rest of the model group were killed. The serum levels of aminotransferase were measured and the histology of livers was observed by H＆E staining. RESULTS： The livers of rats presented the pathological features of steatohepatitis with higher serum levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in the model group after 16 wk. Compared to the model group, the serum levels of ALT and AST in treatment group decreased significantly and were close to the normal group, and the hepatic inflammation scores also decreased markedly than those in the model group after 16 wk （5.83±2.02 vs 3.63±0.64, P〈0.05）, but were still higher than those in the model group after 8 wk （3.63±0.64 vs 1.98±0.90, P〈0.05）. However, the degree of hepatic steatosis had no changes in treatment group compared to the model group after 16 wk. CONCLUSION： Lactulose could ameliorate the hepatic inflammation of rats with steatohepatitis induced by fat- rich diet, but could not completely prevent the development of steatohepatitis. It is suggested that intestinal environmental changes such as intestinal bacteria overgrowth, are one of the important factors in the pathogenesis of NASH.展开更多
目的探讨粪菌移植联合乳果糖对老年慢性功能性便秘的治疗效果。方法以本院2017年9月至2018年9月收治的86例功能性便秘老年患者为对象,按电脑数字表法随机分为两组,每组各43例,对照组予以乳果糖治疗,实验组予以粪菌移植联合果乳糖治疗,...目的探讨粪菌移植联合乳果糖对老年慢性功能性便秘的治疗效果。方法以本院2017年9月至2018年9月收治的86例功能性便秘老年患者为对象,按电脑数字表法随机分为两组,每组各43例,对照组予以乳果糖治疗,实验组予以粪菌移植联合果乳糖治疗,对比两组疗效。结果治疗后,实验组氧菌群酵母菌水平是(4.21±0.20)logN·g^-1,肠杆菌是(8.89±0.22)logN·g^-1,分别较对照组的(5.34±0.14)logN·g^-1、(8.02±0.31)logN·g^-1低,实验组双歧杆菌水平是(9.38±0.21)logN·g^-1,厌氧菌群乳杆菌是(7.17±0.22)logN·g^-1,分别较对照组的(8.31±0.25)logN·g^-1、(6.28±0.15)logN·g^-1高,差异有统计学意义(P<0.05);治疗后,实验组血清血管活性肠肽(vasoactineintrestinalpeptide,VIP)水平较对照组低,乙酰胆碱(acetylcholine,ACH)、c-kit原癌基因(C-KIT)蛋白水平较对照组高,差异有统计学意义(P<0.05);治疗后,实验组胃肠动力的餐前与餐后平均幅值、餐前与餐后平均频率均较对照组高,差异有统计学意义(P<0.05);治疗后,实验组Bristol粪便性状评分(Bristolstoolformscale,BSFS)较对照组高,Wexner便秘评分、便秘患者生活质量评价表(Patient-Assessment of Constipation Quality Of Life,PAC-QOL)评分较对照组低,差异有统计学意义(P<0.05)。结论粪菌移植联合乳果糖治疗老年慢性功能性便秘有助于改善患者肠道菌群及神经递质,并且提升胃肠道动力。展开更多
Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which th...Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which there is overgrowth of bacteria in small bowel in excess of 10<sup>5</sup> colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls. Higher frequency in some studies might be due to fallacious criteria [post-lactulose breath-hydrogen rise 20 PPM above basal within 90 min (early-peak)]. Glucose hydrogen breath test (GHBT) has a low sensitivity to diagnose SIBO. Hence, studies based on GHBT might have under-estimated frequency of SIBO. Therefore, it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected. This review evaluates studies on association between SIBO and IBS, discordance between different studies, their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS.展开更多
Background: Minimal hepatic encephalopathy(MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify ...Background: Minimal hepatic encephalopathy(MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE.Data sources: Seven electronic databases were searched for relevant randomized controlled trials(RCTs)published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated.Results: A total of 14 RCTs(combined n = 1132) were included in the meta-analysis. When probiotics were compared to placebo or no treatment, probiotics were more likely to reduce values in the number connection test(NCT; week 4: MD =-30.25, 95% CI:-49.85 to-10.66), improve MHE(week 4: OR = 0.18,95% CI: 0.07 to 0.47; week 12: OR = 0.15, 95% CI: 0.07 to 0.32), and prevent overt HE progression(week4: OR = 0.22, 95% CI: 0.07 to 0.67) in patients with liver cirrhosis. When probiotics was compared to lactulose, probiotics tended to reduce serum ammonia levels(week 4: MD =-0.33 μmol/L, 95% CI:-5.39 to 4.74; week 8: MD = 6.22 μmol/L, 95% CI:-24.04 to 36.48), decrease NCT(week 8: MD = 3.93, 95% CI:-0.72 to 8.58), improve MHE(week 4: OR = 0.93, 95% CI: 0.45 to 1.91; week 12: OR = 0.73, 95% CI: 0.35 to 1.51) and prevent the development of overt HE(week 4: OR = 0.96, 95% CI: 0.17 to 5.44; week 12:OR = 2.7, 95% CI: 0.50 to 14.64) in patients with liver cirrhosis. However, lactulose appears to be more effective in reducing NCT values as compared to probiotics(week 4: MD = 6.7, 95% CI: 0.58 to 12.82).Conclusion: Probiotics can decrease serum ammonia and endotoxin levels, improve MHE, and prevent overt HE development in patients with liver cirrhosis.展开更多
文摘Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.
文摘Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria (i.e., gram negative species) and a decrease in autochthonous familiae. Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences. We therefore described the features of the complex interaction between gut microbiota and cirrhotic host, the so called “gut-liver axis”, with a particular attention to the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections in the cirrhotic patient. Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis.
文摘AIM： To explore the relationship between changes of intestinal environment and pathogenesis of non-alcoholic steatohepatitis （NASH）. METHODS： Forty-two Sprague-Dawley rats were randomly dMded into model group （n = 24）, treatment group （n = 12）, and control group （n = 6）. The rats of model and treatment groups were given high-fat diet, and those of the control group were given normal diet. Furthermore, the rats of treatment group were given lactulose after 8 wk of high-fat diet. Twelve rats of the model group were killed at 8 wk of high-fat diet. At the 16 wk the rats of treatment group, control group, and the rest of the model group were killed. The serum levels of aminotransferase were measured and the histology of livers was observed by H＆E staining. RESULTS： The livers of rats presented the pathological features of steatohepatitis with higher serum levels of alanine aminotransferase （ALT） and aspartate aminotransferase （AST） in the model group after 16 wk. Compared to the model group, the serum levels of ALT and AST in treatment group decreased significantly and were close to the normal group, and the hepatic inflammation scores also decreased markedly than those in the model group after 16 wk （5.83±2.02 vs 3.63±0.64, P〈0.05）, but were still higher than those in the model group after 8 wk （3.63±0.64 vs 1.98±0.90, P〈0.05）. However, the degree of hepatic steatosis had no changes in treatment group compared to the model group after 16 wk. CONCLUSION： Lactulose could ameliorate the hepatic inflammation of rats with steatohepatitis induced by fat- rich diet, but could not completely prevent the development of steatohepatitis. It is suggested that intestinal environmental changes such as intestinal bacteria overgrowth, are one of the important factors in the pathogenesis of NASH.
文摘目的探讨粪菌移植联合乳果糖对老年慢性功能性便秘的治疗效果。方法以本院2017年9月至2018年9月收治的86例功能性便秘老年患者为对象,按电脑数字表法随机分为两组,每组各43例,对照组予以乳果糖治疗,实验组予以粪菌移植联合果乳糖治疗,对比两组疗效。结果治疗后,实验组氧菌群酵母菌水平是(4.21±0.20)logN·g^-1,肠杆菌是(8.89±0.22)logN·g^-1,分别较对照组的(5.34±0.14)logN·g^-1、(8.02±0.31)logN·g^-1低,实验组双歧杆菌水平是(9.38±0.21)logN·g^-1,厌氧菌群乳杆菌是(7.17±0.22)logN·g^-1,分别较对照组的(8.31±0.25)logN·g^-1、(6.28±0.15)logN·g^-1高,差异有统计学意义(P<0.05);治疗后,实验组血清血管活性肠肽(vasoactineintrestinalpeptide,VIP)水平较对照组低,乙酰胆碱(acetylcholine,ACH)、c-kit原癌基因(C-KIT)蛋白水平较对照组高,差异有统计学意义(P<0.05);治疗后,实验组胃肠动力的餐前与餐后平均幅值、餐前与餐后平均频率均较对照组高,差异有统计学意义(P<0.05);治疗后,实验组Bristol粪便性状评分(Bristolstoolformscale,BSFS)较对照组高,Wexner便秘评分、便秘患者生活质量评价表(Patient-Assessment of Constipation Quality Of Life,PAC-QOL)评分较对照组低,差异有统计学意义(P<0.05)。结论粪菌移植联合乳果糖治疗老年慢性功能性便秘有助于改善患者肠道菌群及神经递质,并且提升胃肠道动力。
文摘Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which there is overgrowth of bacteria in small bowel in excess of 10<sup>5</sup> colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls. Higher frequency in some studies might be due to fallacious criteria [post-lactulose breath-hydrogen rise 20 PPM above basal within 90 min (early-peak)]. Glucose hydrogen breath test (GHBT) has a low sensitivity to diagnose SIBO. Hence, studies based on GHBT might have under-estimated frequency of SIBO. Therefore, it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected. This review evaluates studies on association between SIBO and IBS, discordance between different studies, their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS.
基金supported by grants from the Mega-Project for National Science and Technology Development under the"11th and 12th Five-Year Plan of China"(2013ZX10004901,2013ZX10004904and 2014ZX10004008)
文摘Background: Minimal hepatic encephalopathy(MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE.Data sources: Seven electronic databases were searched for relevant randomized controlled trials(RCTs)published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated.Results: A total of 14 RCTs(combined n = 1132) were included in the meta-analysis. When probiotics were compared to placebo or no treatment, probiotics were more likely to reduce values in the number connection test(NCT; week 4: MD =-30.25, 95% CI:-49.85 to-10.66), improve MHE(week 4: OR = 0.18,95% CI: 0.07 to 0.47; week 12: OR = 0.15, 95% CI: 0.07 to 0.32), and prevent overt HE progression(week4: OR = 0.22, 95% CI: 0.07 to 0.67) in patients with liver cirrhosis. When probiotics was compared to lactulose, probiotics tended to reduce serum ammonia levels(week 4: MD =-0.33 μmol/L, 95% CI:-5.39 to 4.74; week 8: MD = 6.22 μmol/L, 95% CI:-24.04 to 36.48), decrease NCT(week 8: MD = 3.93, 95% CI:-0.72 to 8.58), improve MHE(week 4: OR = 0.93, 95% CI: 0.45 to 1.91; week 12: OR = 0.73, 95% CI: 0.35 to 1.51) and prevent the development of overt HE(week 4: OR = 0.96, 95% CI: 0.17 to 5.44; week 12:OR = 2.7, 95% CI: 0.50 to 14.64) in patients with liver cirrhosis. However, lactulose appears to be more effective in reducing NCT values as compared to probiotics(week 4: MD = 6.7, 95% CI: 0.58 to 12.82).Conclusion: Probiotics can decrease serum ammonia and endotoxin levels, improve MHE, and prevent overt HE development in patients with liver cirrhosis.
