RESUMEN
BACKGROUND AND AIMS: Left ventricular diastolic dysfunction (LVDD) in cirrhotics are associated with circulatory dysfunction, hepatorenal syndrome (HRS) and heart failure in stressful conditions. Transjugular intrahepatic portosystemic shunt (TIPS) exacerbates the hyperdynamic circulation and challenges cardiac function. We evaluated the incidence and the impact of LVDD in cirrhotic candidates to TIPS for refractory ascites. METHODS: Among 135 patients who underwent TIPS for refractory ascites, 63 cases (child B/C 53/10, Na-model for end-stage liver disease 16.5 ± 0.9) who had 2D-transthoracic-echocardiography with tissue-Doppler-imaging pre-TIPS were retrospectively analysed (group A); in 23 cases cardiac and hormonal assessment before and after TIPS was available. 41 cirrhotics without refractory ascites treated by banding ligation for variceal re-bleeding were used as controls (group B). RESULTS: The prevalence of LVDD was higher in group A (59%; 22% with grade ≥2) as compared to group B (35%; 7% with grade ≥2) (P < 0.01 and P < 0.03). A lack of clinical response to TIPS occurred in 10 patients, all with LVDD (P < 0.03 vs. no LVDD) and in patients with grade ≥2 LVDD mostly (P < 0.02 vs. grade 1). Central venous pressure >20 mmHg after TIPS and left ventricular end-diastolic volume at basal were predictors of no response to TIPS (P = 0.01 and P = 0.004, respectively), which was an independent predictor of death. Elevated levels of NT-proBNP 3 days after TIPS were associated with advanced cardiac dysfunction (P = 0.005). CONCLUSION: NT-proBNP and careful LVDD investigation are useful to better select patients and to predict clinical response and mortality after TIPS.
Asunto(s)
Enfermedad Hepática en Estado Terminal , Derivación Portosistémica Intrahepática Transyugular , Ascitis/complicaciones , Ascitis/cirugía , Niño , Enfermedad Hepática en Estado Terminal/complicaciones , Humanos , Cirrosis Hepática/complicaciones , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Derivación Portosistémica Intrahepática Transyugular/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Enfermedades Inflamatorias del Intestino , Microbiota , Probióticos , Disbiosis , Humanos , Prebióticos , Arabia SauditaRESUMEN
OBJECTIVE: The aim of this study was to assess the safety and efficacy of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) in patients with inflammatory bowel disease (IBD). METHODS: An LFD is associated with symptom improvement in patients with functional intestinal disorders, although its safety and efficacy has not been characterized in patients with IBD. Fifty-five patients with IBD in remission or with mild disease activity were randomized to a 6-wk LFD or standard diet (SD). Disease activity (Harvey-Bradshaw index [HBi], partial Mayo score), fecal calprotectin, and disease-specific quality of life (IBD-Q) were assessed at baseline and at the end of dietary intervention. RESULTS: After the 6-wk dietary intervention, median HBi decreased in the LFD (4; IQR, 3-5 versus 3; IQR, 2-3; Pâ¯=â¯0.024) but not in the SD (3; IQR, 3-3 versus 3; IQR, 2-4), whereas Mayo scores were numerically decreased in the LFD group and unmodified in the SD group. Median calprotectin decreased in the LFD (76.6 mg/kg; IQR, 50-286.3 versus 50 mg/kg; IQR, 50.6-81; Pâ¯=â¯0.004) but not in the SD group (91 mg/kg; IQR, 50.6-143.6 versus 87 mg/kg; IQR, 50-235.6). Lastly, we observed a barely significant increase in median IBD-Q in the LFD group (166; IQR, 139-182 versus 177; IQR, 155-188; Pâ¯=â¯0.05) and no modification in the SD group (181; IQR, 153-197 versus 166; IQR, 153-200). CONCLUSIONS: A short-term, LFD is safe for patients with IBD, and is associated with an amelioration of fecal inflammatory markers and quality of life even in patients with mainly quiescent disease.
Asunto(s)
Colitis Ulcerosa/dietoterapia , Enfermedad de Crohn/dietoterapia , Dieta Baja en Carbohidratos/métodos , Adulto , Biomarcadores/análisis , Colitis Ulcerosa/metabolismo , Enfermedad de Crohn/metabolismo , Disacáridos , Heces/química , Femenino , Fermentación , Humanos , Complejo de Antígeno L1 de Leucocito/análisis , Masculino , Persona de Mediana Edad , Monosacáridos , Oligosacáridos , Polímeros , Estudios Prospectivos , Calidad de Vida , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: The use of therapeutic drug monitoring has been proposed as a useful tool in the management of patients with loss of response to biological therapy in patients with inflammatory bowel disease. AIMS: To evaluate whether early, post-induction anti-tumor necrosis factor trough levels and the presence of different types of anti-drug antibodies may impact long-term clinical remission in patients with inflammatory bowel disease. METHODS: We prospectively assessed anti-tumor necrosis factor trough levels and both persistent and transient anti-drug antibodies. The Harvey-Bradshaw Index and the partial Mayo score were evaluated at each visit or in case of relapse. RESULTS: At week 14, median infliximab trough levels were significantly lower in patients who experienced loss of response at week 48 as compared to patients in stable remission (1.3mcg/mL [range 0-10.2mcg/mL] vs. 10.1mcg/mL[range 0-42.8mcg/mL], P<0.0004). ROC curve identified an infliximab trough levels of 6.2mcg/mL as the cut-off value with the highest accuracy (c-index=0.864) for loss of response at week 48. At week 14 we observed a correlation between anti-drug antibodies concentration and infliximab trough levels (rs=-0.513, P=0.04). CONCLUSIONS: The results highlight the usefulness of assessing early biological TL in order to predict patients' long-term outcome.