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World Journal of Hepatology Dec 2020Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies. In this review, we aim to provide an overview of the... (Review)
Review
Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies. In this review, we aim to provide an overview of the available evidence on esophageal motility disorders in cirrhosis and their clinical implications. This review delves into the following concepts: (1) Gastroesophageal reflux disease is common in liver cirrhosis due to many mechanisms; however, when symptomatic it is usually nocturnal and has an atypical presentation; (2) Endoscopic band ligation is better than sclerotherapy in terms of its effect on esophageal motility and seems to correct dysmotilities resulting from the mechanical effect of esophageal varices; (3) Chronic alcoholism has no major effects on esophageal motility activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy; (4) An association between primary biliary cholangitis and scleroderma can be present and esophageal hypomotility is not uncommon in this scenario; and (5) Cyclosporin-based immunosuppression in liver transplant patients can have a neurotoxic effect on the esophageal myenteric plexus leading to reversible achalasia-like manifestations.
PubMed: 33442445
DOI: 10.4254/wjh.v12.i12.1158 -
Cureus Nov 2020Tobacco and alcohol dependence are known to cause choroidal neovascularization and toxic optic neuropathy, although these typically occur in isolation. In this case...
Tobacco and alcohol dependence are known to cause choroidal neovascularization and toxic optic neuropathy, although these typically occur in isolation. In this case report, we describe a 54-year-old male who presented with a juxtafoveal choroidal neovascular membrane (CNVM) in the left eye. Over the course of the next two years, his vision worsened significantly in both eyes, and he developed decreased color vision and paracentral scotomas. Impaired photoreceptor response was detected on full-field electroretinography in both eyes. MRI of the brain and orbits was normal, and laboratory tests for optic neuropathy were within normal limits, except for highly elevated cotinine and nicotine levels. He was in the habit of chewing tobacco nearly constantly, and he admitted to drinking 15-20 alcoholic beverages per week. He was diagnosed with choroidal neovascularization and optic atrophy due to tobacco and alcohol overuse. The effects of tobacco and alcohol use on the health of the choroidal vasculature and optic nerve are discussed in the article.
PubMed: 33335822
DOI: 10.7759/cureus.11493 -
Revista Espanola de Enfermedades... Apr 2021the autonomic dysfunction defines the neuropathy of the autonomic nervous system. The prevalence of the gastric dysmotility and its relationship with the autonomic...
BACKGROUND
the autonomic dysfunction defines the neuropathy of the autonomic nervous system. The prevalence of the gastric dysmotility and its relationship with the autonomic dysfunction in patients with alcohol chronic liver disease is not well known.
METHODS
thirty-six patients with alcohol chronic liver disease and 25 healthy controls were evaluated, in order to detect an autonomic dysfunction through different cardiovascular reflexes and gastric emptying tests.
RESULTS
ninety-four per cent of the patients showed an impaired R index (variations in heart rate during six deep inspirations-expirations per minute) and/or S/S-HR (variations in heart rate when standing from a supine position). Seventy-five per cent of the patients showed gastroparesis (T1/2: gastric half-emptying time was delayed). There was a correlation between the R index and T1/2 (r = -0.49; p < 0.01).
CONCLUSIONS
we suggest that gastroparesis detected in alcoholic chronic liver disease is another clinical manifestation of the autonomic parasympathetic dysfunction.
Topics: Autonomic Nervous System; Autonomic Nervous System Diseases; Gastric Emptying; Gastroparesis; Humans; Liver Diseases
PubMed: 33233909
DOI: 10.17235/reed.2020.7303/2020 -
Open Access Macedonian Journal of... Sep 2019Pseudo-ainhum is defined as any case of auto-amputation not associated with the classic spontaneous ainhum seen in Africans with unknown etiology.
BACKGROUND
Pseudo-ainhum is defined as any case of auto-amputation not associated with the classic spontaneous ainhum seen in Africans with unknown etiology.
CASE PRESENTATION
A severely ill 58-year-old male patient presented with a painless constricting circular band on his left second toe. His medical history was remarkable for severe alcoholic liver cirrhosis with ascites formation leading to dyspnea. He had a hypoalbuminemia and a pronounced peripheral sensory neuropathy.
CONCLUSION
Here we present the second case of pseudo-ainhum associated with liver cirrhosis.
PubMed: 31850112
DOI: 10.3889/oamjms.2019.681 -
Diabetes, Metabolic Syndrome and... 2019Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of complications in type 1 diabetes (T1DM) patients. To date, several biochemical indexes...
INTRODUCTION
Non-alcoholic fatty liver disease (NAFLD) is associated with an increased risk of complications in type 1 diabetes (T1DM) patients. To date, several biochemical indexes of NAFLD have been developed. Among these, hepatic steatosis index (HSI) strongly relates with the results of magnetic resonance.
AIM
The aim of the present study was to evaluate the possible association between HSI and complications in T1DM.
METHODS
Medical records of patients with T1DM were evaluated. Macro- and micro-vascular complications were evaluated by a combination of instrumental (ECG, carotid artery echo-Doppler, fundus examination, vibration threshold at biothesiometry) and laboratory examination. HSI was calculated based on gender, body mass index and transaminases level.
RESULTS
Of the 124 patients evaluated, 71 were free of complications and 53 had at least one complication. The prevalence of diabetes complications was: 27% for retinopathy, 15% for carotid atherosclerosis, 16% for neuropathy. HSI was directly correlated with age, disease duration, triglycerides, total daily insulin and inversely with HDL and eGFR. In logistic regression analysis, HSI was independently associated with diabetic complications.
CONCLUSION
These findings show that HSI is independently associated with the presence of complications in subjects with T1DM. This can be of clinical utility, allowing a better diagnostic classification of the patient and possibly guiding the therapeutic choice.
PubMed: 31819566
DOI: 10.2147/DMSO.S221969 -
The Journal of Clinical Investigation Dec 2019Excessive alcohol consumption is associated with spontaneous burning pain, hyperalgesia, and allodynia. Although acetaldehyde has been implicated in the painful...
Excessive alcohol consumption is associated with spontaneous burning pain, hyperalgesia, and allodynia. Although acetaldehyde has been implicated in the painful alcoholic neuropathy, the mechanism by which the ethanol metabolite causes pain symptoms is unknown. Acute ethanol ingestion caused delayed mechanical allodynia in mice. Inhibition of alcohol dehydrogenase (ADH) or deletion of transient receptor potential ankyrin 1 (TRPA1), a sensor for oxidative and carbonyl stress, prevented allodynia. Acetaldehyde generated by ADH in both liver and Schwann cells surrounding nociceptors was required for TRPA1-induced mechanical allodynia. Plp1-Cre Trpa1fl/fl mice with a tamoxifen-inducible specific deletion of TRPA1 in Schwann cells revealed that channel activation by acetaldehyde in these cells initiates a NADPH oxidase-1-dependent (NOX1-dependent) production of hydrogen peroxide (H2O2) and 4-hydroxynonenal (4-HNE), which sustains allodynia by paracrine targeting of nociceptor TRPA1. Chronic ethanol ingestion caused prolonged mechanical allodynia and loss of intraepidermal small nerve fibers in WT mice. While Trpa1-/- or Plp1-Cre Trpa1fl/fl mice did not develop mechanical allodynia, they did not show any protection from the small-fiber neuropathy. Human Schwann cells express ADH/TRPA1/NOX1 and recapitulate the proalgesic functions of mouse Schwann cells. TRPA1 antagonists might attenuate some symptoms of alcohol-related pain.
Topics: Acetaldehyde; Animals; Ethanol; HEK293 Cells; Humans; Male; Mice; Mice, Inbred C57BL; NADPH Oxidase 1; Neuralgia; Reactive Oxygen Species; Schwann Cells; TRPA1 Cation Channel
PubMed: 31487269
DOI: 10.1172/JCI128022 -
Turkish Journal of Physical Medicine... Mar 2019Peroneal palsy is compression neuropathy of the peroneal nerve, which presents with foot drop. Patients with unilateral peroneal nerve palsy are frequently encountered...
Peroneal palsy is compression neuropathy of the peroneal nerve, which presents with foot drop. Patients with unilateral peroneal nerve palsy are frequently encountered in clinical practice. Although bilateral peroneal nerve palsy is rare, bilateral foot drop due to peroneal nerve palsy is much less common. The main complaint is often walking difficulty due to weakened ankle dorsiflexor muscles. Medical history and physical examination are always a part of the diagnosis, and the most useful method is electroneuromyography to evaluate the degree of the lesion. In this report, we present a 52-year-old male unconscious patient with chronic alcoholism admitted with acute bilateral foot drop and discuss clinical assessment, diagnosis, and treatment planning of this rare case of peroneal palsy after lying in the prone position in the light of literature data.
PubMed: 31453549
DOI: 10.5606/tftrd.2019.2244 -
Revue Medicale de Liege May 2019Chronic alcohol consumption results in multiple peripheral and central nervous system dysfunctions. Some are due to the direct action of alcohol or its derivatives,... (Review)
Review
Chronic alcohol consumption results in multiple peripheral and central nervous system dysfunctions. Some are due to the direct action of alcohol or its derivatives, others are induced by the vitamin deficiencies associated with alcoholism, others are eventually related to the failure of other vital organs, such as the liver. In this short review, we describe alcohol-induced neuropathy, Gayet-Wernicke syndrome, Korsakoff syndrome, alcoholic dementia, Marchiafava-Bignami syndrome, hepatic encephalopathy, alcoholic epilepsy and manifestations of alcohol withdrawal.
Topics: Alcoholism; Dementia; Hepatic Encephalopathy; Humans; Wernicke Encephalopathy
PubMed: 31206272
DOI: No ID Found -
Annals of Translational Medicine Apr 2019The understanding and management of Wilson disease (WD) have dramatically improved since the first description of the disease by K. Wilson more than a century ago.... (Review)
Review
The understanding and management of Wilson disease (WD) have dramatically improved since the first description of the disease by K. Wilson more than a century ago. However, the persistent long delay between the first symptoms and diagnosis emphasizes challenges in diagnosing earlier this copper overload disorder. As a treatable disease, WD should be detected early in the course of the disease by any health professionals at any care level, but the rare prevalence of the disease explains the lack of awareness of referring physicians. The most important challenge is to train physicians to recognize atypical or rare symptoms of WD that will lead to discuss the diagnosis more systematically. Atypia can come from the age of onset, the liver [non-alcoholic steatohepatitis (NASH) presentation], the central or peripheral nervous system (neuropathy, epilepsy, sleep disorders…) or may be due to lesions of other organs (renal manifestations, osteo-articular disorders or endocrine disturbances). Isolated biological anomalies, rare radiological findings or inadequate interpretation of copper test may also lead to misdiagnosis. The second challenge is to confirm the diagnosis faster and more effectively so as not to delay the initiation of treatment, and expand family screening as the genetic prevalence is higher than previously expected. Generalization of the exchangeable copper assay and the next generation sequencing (NGS) are two promising ways to overcome this ultimate challenge. By drawing attention to the earliest and rare symptoms and to new biomarkers and diagnostic tools, we hope that this article will increase diagnostic awareness and reduce delays so that patients can start their treatment earlier in the course of the illness and thus have a better disease prognosis.
PubMed: 31179304
DOI: 10.21037/atm.2019.02.10 -
Journal of Clinical and Experimental... 2019Small intestinal bacterial overgrowth (SIBO) is defined by increased density and/or abnormal composition of microbiota in the small bowel. SIBO is often encountered in... (Review)
Review
Small intestinal bacterial overgrowth (SIBO) is defined by increased density and/or abnormal composition of microbiota in the small bowel. SIBO is often encountered in patients with cirrhosis as a result of impaired intestinal motility and delayed transit time, both of which are exacerbated by more severe liver disease. Additional risk factors for SIBO commonly encountered in cirrhotic patients include coexisting diabetes, autonomic neuropathy, and/or alcoholic use. Diagnosis of SIBO is performed by breath testing or jejunal aspiration, the gold standard. In cirrhotic patients, the presence of SIBO can lead to profound clinical consequences. Increased intestinal permeability in these patients predisposes to bacterial translocation into the systemic circulation. As a result, SIBO is implicated as a significant risk factor in the pathogenesis of both spontaneous bacterial peritonitis and hepatic encephalopathy in cirrhotics. Antibiotics, especially rifaximin, are the best studied and most effective treatment options for SIBO. However, prokinetics, probiotics, nonselective beta-blockers, and treatment of underlying liver-related pathophysiology with transjugular intrahepatic portosystemic shunt placement or liver transplantation are also being investigated. This review will discuss the risk factors, diagnosis, manifestations in cirrhosis, and treatment options of SIBO.
PubMed: 31024208
DOI: 10.1016/j.jceh.2018.08.006