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The introduction of ursodeoxycholic acid (UDCA) in the treatment of patients with cholestasis enabled remarkable progress and improvements in hepatic inflammatory activity, progression to cirrhosis and quality of life. However, the benefits of UDCA are particularly evident in patients with primary biliary cirrhosis and also 30 percent of patients have sub optimal response. For this reason, in order to improve the number of people with complete responses to therapy, new pharmacological alternatives have been investigated to add to UDCA treatment. This review aims to show potential new therapies against cholestasis that have been investigated by systematizing them depending on the receptor or target on which they act. Finally, a special reference will be made in relation to the treatment of pruritus associated with cholestasis.

La introducción del ácido ursodeoxicólico (AUDC) en el tratamiento de los pacientes con colestasia permitió notables avances con mejoras en la actividad inflamatoria hepática, progresión hacia la cirrosis y calidad de vida. Sin embargo, los beneficios de AUDC se aprecian especialmente en pacientes con cirrosis biliar primaria y además, 30 por ciento de los pacientes tiene una respuesta sub óptima. Por esta razón, con la finalidad de mejorar el número de personas con respuestas completas a la terapia, se han investigado nuevas alternativas farmacológicas para adicionar al tratamiento con AUDC. La presente revisión pretende mostrar las nuevas posibles terapias contra la colestasia estudiadas sistematizándolas según el tipo de receptor o diana sobre el que actúan. Finalmente se hará referencia especial en relación al tratamiento del prurito asociado a la colestasia.

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The decompensation of liver cirrhosis secondary to an identifiable injury (mainly infections among the potential causes) associated to failure of one or more organs (particularly the kidney). Proinflammatory citokines are involved in pathophysiology, produced as a consequence of the injury that triggers the condition. Mortality factors are the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA); Model-For-End-Stage-Liver Disease (MELD); number of organs affected, and presence of leukocytosis. No specific treatment has been described yet that might have an impact on the mortality rates, therefore emphasis should made on prevention and/or diagnosis for early treatment of injuries (pneumonia and Spontaneous Bacterial Peritonitis-SBP among others) in order to prevent synthesis of cytokines that have a role in its pathophysiology.

La falla hepática aguda sobre crónica corresponde a una situación de alta mortalidad, pero potencialmente reversible. Conceptualmente corresponde a la descompensación de la cirrosis hepática secundaria a un daño cuya etiología es muchas veces identificable (destacando las infecciones entre las posibles causas) asociada a la falla de uno o más órganos (especialmente el riñón). En su patogenia actúan en forma importante citoquinas proinflamatorias que se generan como consecuencia del daño que gatilla el cuadro. Son factores pronósticos de mortalidad el Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA); Model-For-End-Stage-Liver Disease (MELD); número de órganos disfuncionantes y existencia de leucocitosis. Aún no se ha descrito ningún tratamiento específico que impacte en la mortalidad del cuadro, por lo que se debe enfatizar en prevenir y/o diagnosticar para tratar precozmente las causas de daño (neumonía y peritonitis bacteriana espontánea- PBE entre otros) y así evitar la síntesis de citoquinas que participan en su patogenia.

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INTRODUCCIÓN: El hígado graso no alcohólico puede abarcar desde una simple esteatosis hasta una cirrosis hepática. Los mecanismos fisiopatológicos que modulan el estrés oxidativo, la actividad inflamatoria y profibrótica, deberían ser cruciales en su mayor o menor agresividad hepática y vascular. Un compuesto derivado de la Cúrcuma longa L, la curcumina, poseería propiedades vasoprotectoras. OBJETIVO: Comparar en situaciones de dieta hipercolesterolémica los cambios vasculares entre ratas macho Sprague Dawley que consumen curcumina y las que no consumen. MATERIAL Y MÉTODO: Estudio analítico, experimental, longitudinal y prospectivo en ratas macho Sprague-Dawley expuestas a condiciones de hígado graso no alcohólico e hígado graso no alcohólico adicionando curcumina, durante 4 meses. Sacrificadas, se realizó protocolo de función vascular en arteria mesentérica superior aislada (respuesta a acetilcolina, N nitro-L-arginina metil éster y nitroprusiato) y medición de presión portal por punción directa. Los resultados fueron expresados en promedios junto a la desviación estándar de la media. Lasdiferencias entre los grupos fueron probadas mediante t de Studenty test de Mann-Whitney. RESULTADOS: La medición de presión portal no mostró diferencias significativas entre ambos grupos. No hubo diferencias significativas en las pruebas con Nnitro-L-arginina metil éster ni nitroprusiato; diferencia que sí existió con acetilcolina entre la dilatación de la arteria mesentérica superior de hígado graso no alcohólico y las de hígado graso no alcohólico más curcumina. DISCUSIÓN: La curcumina mejoró la respuesta vasodilatadora a acetilcolina, lo que sugiere que el posible efecto antioxidante sería mejorando la función endotelial. Se sugiere su futuro uso terapéutico.

INTRODUCTION: Nonalcoholic fatty liver disease can range from simple steatosis to cirrhosis. The pathophysiological mechanisms that modulate oxidative stress, inflammatory and profibrotic activity should be crucial in the liver injury and vascular aggressiveness. Curcumin, a compound derived from Curcuma longa L, possesses vasoprotectives properties. OBJECTIVE: To compare in hypercholesterolemic diet situations the vascular changes between Sprague-Dawley male rats who consume curcumin and who do not consume. MATERIAL AND METHOD: Analytical, experimental, prospective and longitudinal study in Sprague-Dawley male rats exposed to conditions of Nonalcoholic fatty liver with and without curcumin, for four months. After the sacrifice, a vascular function protocol was performed on an isolated superior mesenteric artery (response to acetylcholine, L-NGNitroarginine Methyl Ester and nitroprusside) and measurement of portal pressure by direct puncture. The results were expressed as average and the standard deviation of the central tendency. The differences between the groups were tested using Student's t-test and Mann-Whitney test. RESULTS: The portal pressure measurement showed no significant differences between groups. There was no significant difference in the nitroprusside test, in the other hand, exist a difference with acetylcholine between arteries of nonalcoholic fatty liver group against nonalcoholic fatty liver plus curcumin group. DISCUSSION: Curcumin improved the vasodilator response in response to acetylcholine, suggesting a possible antioxidant effect which improves endothelial function. It is suggested for future therapeutic use.

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La peritonitis bacteriana espontánea es la infección más característica del cirrótico, asociándose a un mal pronóstico a corto y mediano plazo. El presente artículo pretende revisar los mecanismos fisiopatológicos más importantes en su génesis, con especial énfasis en aquellos que favorecen la translocación bacteriana (sobrecrecimiento bacteriano y pérdida de barrera intestinal). Igualmente se analizan los eventos involucrados en el agravamiento del paciente con peritonitis bacteriana en curso, y las medidas profilácticas y terapéuticas que se derivan del conocimiento de los mecanismos fisiopatológicos.

The spontaneous bacterial peritonitis is the most typical infection in cirrhotic patients being associated with a bad short and long-term prognosis. The present article tries to review the most important pathophysiological mechanisms in their genesis, with special emphasis on those that favor bacterial translocation (intestinal bacterial overgrowth and loss of intestinal barrier). Equally, this article analyzes events that are involved in the worsening of the patient with bacterial peritonitis in course, and the prophylactic and therapeutic measures resulting from the knowledge of the pathophysiological mechanisms.

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Tuberculosis rates in Chile are higher than expected during the last years. This is directly related to the increase of immunodeficiency associated to human immunodeficiency virus (HIV) infection. Gastrointestinal tuberculosis is the sixth in frequency of extra pulmonary localizations. We report an HIV(+) 55 year-old male, that presented with fever and epigastric pain. In an upper GI endoscopy small elevated lesions were described in the esophagus. Pathological study was suggestive of tuberculous infection. The definitive diagnosis of esophageal tuberculosis was obtained by a PCR test of the biopsy sample. Antituberculous therapy was started and one year later there was a regression but not disappearance of esophageal lesions and granulomas in the pathological study.

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Tuberculosis rates in Chile are higher than expected during the last years. This is directly related to the increase of immunodeficiency associated to human immunodeficiency virus (HIV) infection. Gastrointestinal tuberculosis is the sixth in frequency of extra pulmonary localizations. We report an HIV(+) 55 year-old male, that presented with fever and epigastric pain. In an upper GI endoscopy small elevated lesions were described in the esophagus. Pathological study was suggestive of tuberculous infection. The definitive diagnosis of esophageal tuberculosis was obtained by a PCR test of the biopsy sample. Antituberculous therapy was started and one year later there was a regression but not disappearance of esophageal lesions and granulomas in the pathological study.

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