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Objective: the hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC). Patients and methods: serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin. Results: serum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F ≥ 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy. Conclusion: serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.Objetivo: el factor de crecimiento hepatocitario (HGF) es una citocina pleiotrópica producida por las células estrelladas hepáticas, que está implicada en la regeneración y la fibrosis hepática. La concentración sérica del HGF en las enfermedades hepáticas es variable, reflejando daño hepático y disfunción hepatocelular. En este estudio se ha analizado la concentración sérica del HGF en pacientes con hepatitis crónica por virus de la hepatitis C (VHC) y su relación con los datos bioquímicos, histológicos y virológicos. Pacientes y métodos: se determinó la concentración sérica de HGF mediante ELISA en sándwich y se analizó la correlación entre los niveles del HGF y los datos histológicos (actividad necroinflamatoria, estadio de fibrosis), bioquímicos (transaminasas, actividad de protrombina, albúmina, bilirrubina) y virológicos (carga viral VHC) en 45 pacientes con hepatitis crónica C (HCC). También fueron evaluadas las cifras del HGF en el suero de un subgrupo de pacientes de la muestra original sometidos a tratamiento antiviral con interferón y ribavirina. Resultados: la concentración sérica del HGF en pacientes con HCC fue significativamente mayor que la medida en controles sanos. Los pacientes con fibrosis hepática significativa (F ≥ 2) tenían una edad significativamente mayor, unas cifras plaquetarias significativamente inferiores y concentraciones séricas significativamente superiores de AST, GGT y HGF, en comparación con aquellos pacientes con un índice de fibrosis F < 2. En el análisis multivariante la concentración de HGF fue la única variable independiente asociada a la fibrosis significativa. El área bajo la curva ROC (receiver operating curve), usando las concentraciones séricas de HGF, mostró valores similares a los obtenidos con otros índices, previamente validados, que estiman fibrosis significativa en pacientes con HCC. Sin embargo, las cifras del HGF no descendieron de modo significativo en aquellos pacientes con respuesta sostenida a tratamiento antiviral. Conclusión: la concentración sérica del HGF se correlaciona con el índice de fibrosis en pacientes con HCC, pero es un marcador poco sensible para monitorizar la respuesta inducida por el tratamiento antiviral.

We present the endoscopic finding of a juxtapapillary duodenal pyogenic granuloma in a patient under study for chronic recurrent anemia. The images show the presence of an enlarged papilla, with an exophytic growth of erythematous and friable tissue at its lower border. Although this is a very rare entity, it is necessary to take it into account in the differential diagnosis of refractory anemia because there is an effective endoscopic treatment for it.

Cystic pancreatic neuroendocrine tumors (cP-NET) are a diagnostic challenge for clinic, since sometimes nor imaging features, cytology, or the study of biological markers in pancreatic cyst fluid (PCF), are able to provide the nature of the lesion, and therefore the definitive diagnostic is often made in the surgical piece. Is not infrequent that the lesions are wrongly defined as benign, in special when the cytology is negative for malignancy and the PCL is not mucinous and has a high glucose and a low CEA. We could incorporate new markers to improve the diagnostic performance of PCF samples, like chromogranin A, as in our case may be the only specific finding to detect a cP-TNE.

The Spanish Society of Gastroenterology (SEPD) has published a consensus document that discusses the key standards and recommendations for organizing digestive system units (DSUs) in the 21st century. This is aimed at quality, efficient and patient-centered health care.

Background: the training program of the gastroenterology specialty that is mandatory for resident physicians, obliges them to be proficient in diagnostic and therapeutic digestive ultrasound tools., Methodology: the Asociación Española de Ecografía Digestiva (AEED) performed a survey of the 93 Departments of Gastroenterology with training programs for resident physicians in gastroenterology, in order to assess the exact situation of training in digestive ultrasound in Spain., Results: only 31 of the 93 (33%) Departments of Gastroenterology were able to provide training in Digestive Ultrasound. Moreover, 33% (48 out of 148) of the residents in gastroenterology did not receive specific training in digestive ultrasound. Whereas, 31% (46 out of 148) had received some specific training, but with ample room for improvement. These deficiencies were spread throughout the Spanish regions (Autonomous Communities) in an uneven manner, with almost half totally lacking gastroenterology departments that were capable of providing digestive ultrasound training., Conclusions: there is a significant deficit of gastroenterology departments capable of providing training in digestive ultrasound to residents, causing a significant training inequality. Until this situation can be reversed, the AEED has designed a training project in digestive ultrasound aimed at providing adequate training to all residents in gastroenterology as required.

The sinusoidal obstruction syndrome (SOS) is an uncommon form of portal hypertension that occurs in hematopoietic-cell transplant recipients who receive intense conditioning treatments. The diagnosis is clinical and it is usually delayed, because in these patients there are many causes that can damage the liver and can delay its detection. We present the case of a 47-year-old man, whose diagnosis was made with clinical and analytical data supported by ultrasound signs that showed hepatic congestion. After treatment with defibrotide the patient improved clinically and analytically. Hepatic vascularization and perfusion also improved. Therefore, abdominal doppler ultrasound is shown as a noninvasive exploration useful for the clinical management of SOS and as an early marker of good clinical evolution.