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Pacientes con enfermedad hepática crónica de cualquier etiología que se infectan con SARS-CoV-2 tienen un mayor riesgo de mortalidad en comparación con aquellos pacientes que no tienen enfermedad hepática crónica. Se llevó a cabo una revisión de la literatura en relación a lo publicado de COVID 19 y enfermedad hepática pre-existente. La proporción de pacientes con COVID-19 con función hepática anormal al ingreso osciló entre el 40 % y el 75 % y la proporción con daño hepático fue cercana al 30 %. Los estudios actuales muestran una asociación importante entre la enfermedad hepática preexistente y la COVID-19. La presencia de cirrosis es ahora un predictor independiente de gravedad para COVID-19 y hospitalización prolongada en este grupo de pacientes. Los pacientes con cirrosis tienen una mayor tasa de mortalidad y esta tasa se incrementa con el aumento de la gravedad de la enfermedad hepática.

Introduction and Objectives: Liver damage from alcohol consumption is different between genders, and the susceptibility shown by women is greater than that of men; there are several factors for this difference to exist. We evaluated the complications of cirrhosis due to alcohol in a group of women and compared it with a group of men. This study aimed to compare the effect of alcohol consumption and complications between both genders. Materials and Methods: An observational, descriptive, and analytical study compares the pattern of alcohol consumption, the number of grams of alcohol between men and women, and its complications. Results: 222 patients were included; 122 women (55.0%) with 51.7±11.5 years of age, Child-Pugh A=24 (10.8%), B=69 (30.6%) and C=130 (58.6%). The grammage/day of alcohol was Women 175.6.9±131.4 and Men 301.5±106.7. The type of consumption was regular risk M=6.6%; excessive M=45.9% and H=58.0%; intoxication M=11.5% and H=8.0%; binge M=36.1% and H=34.0%. Next, the comparison of medians with the Mann-Whitney U test for MIH by type of consumption with significant differences is described (see table 1) Conclusions: It was found that women develop more liver damage and more complications with lower consumption of grams of alcohol.

Introduction and Objectives: Severe alcoholic hepatitis (AH) has a high mortality rate, and currently, it is still a challenge to be able to establish the prognosis of these patients and their risk of death at admission in order to be able to offer better therapeutic alternatives that save a life in a timely manner. This study aimed to compare several prognostic scores to verify which of them has the best performance in predicting 28-day mortality at admission in patients with AH. Materials and Methods: Observational, cohort study. Data were collected from patients with severe AH who were hospitalized between January 2010 to May 2022. MELD, MELDNa, MELD3.0, ABIC, Maddrey, Glasgow scale for AH were calculated with admission parameters, and their outcome was verified at 28 days. ROC curves were constructed to compare the different prognostic scales. Results: 144 patients were included, 129 (89.6%) men, mean age 43.3±9.3 years, median grams of alcohol consumed/day were 320 (range: 60-1526). 65 (45.1%) died. The mean of MELD, MELDNa and MELD3.0 were higher among the deceased vs. survivors (33.5±7.5 vs. 27.1±6.2; 34.6±5.7 vs. 29.1±5.7; and 35.8±6.0 vs. 30.1±5.5 respectively; p

Introduction and Objectives: It has already been reported that elevated serum levels were present in Hepatitis C patients, although they were found inactive. The behavior of gelatinases MMP-2 and -9 is yet unknown in other liver diseases. This study aimed to evaluate serum concentration of MMP-2 and -9 in different etiologies of liver disease also according to fibrosis stages. Materials and Methods: Cross-sectional multicentric study, including subjects with no alcoholic fatty liver disease (NAFLD), chronic Hepatitis C (CHC), alcohol cirrhosis (CiOH) and alcoholism (OH), groups with alcohol drinking habits were classified according to WHO criteria, with clinical and biochemical evidence of alcoholic liver disease (ALD). Transient elastography (Fibroscan) was performed in NAFLD and CHC, considering mild fibrosis (FL: F0, F1, F2) and severe fibrosis (FA: F3, F4). As controls, subjects without alcohol consumption (CT) were recruited. Multiplex®-MERCK© was used for MMP-2 and -9 quantification. Statistical analysis was performed by Mann Whitney-U test, p

Introduction and Objectives: Minimal hepatic encephalopathy (MHE) is associated with the risk of accidents, falls, and impaired quality of life. Treatment with L-ornithine L-aspartate (LOLA) could be an effective strategy. This study aimed to verify the efficacy and safety of LOLA treatment in a real-life cohort of cirrhotic patients with MHE. Materials and Methods: Cirrhotic patients with MHE were included. Those who had received any anti-ammoniacal measure or with alcohol consumption in the last six months, creatinine > 1.5 mg/dL, or previously known chronic kidney disease were excluded. The diagnosis of MHE was made using the psychometric hepatic encephalopathy score (PHES) and the critical flicker frequency (CFF). MHE patients received LOLA 6 g t.i.d. for three days and were reassessed with PHES and CFF. The project was approved by the local research and ethics committees. Results: 98 cirrhotic patients were evaluated; 38 (38.8%) had baseline MHE, 26 (68.4%) women, mean age 53.3±8.8 years, median education nine years (range 0-15). According to Child-Pugh: 26 (68.4%) A, 9 (23.7%) B, and 3 (7.9%) C. The median MELD was 11 (range 6-21), and MELD-Na 12 (range 6-26). Intention to treat analysis: According to PHES, 30(78.9%) patients showed remission of MHE (p

Introduction and Objectives: Chronic liver diseases are characterized by persistent inflammation related to high production of cytokines such as IL-12 and chemokine CXCL-10/IP-10 that attract activated Th1 lymphocytes that increase the production of IFN-g and TNF-a, perpetuating the inflammatory cascade. This study aimed to compare serum levels of IL-12 and CXCL-10 in different etiologies of liver disease. Materials and Methods: A cross-sectional and multicenter study was carried out, including subjects with alcoholism according to criteria WHO, without (OH) and with liver injury (cirrhosis, CiOH) and (Alcoholic Hepatitis, HA); non-alcoholic fatty liver (NAFLD) and chronic Hepatitis C (CHC), diagnosed by clinical, biochemical data. They were compared with control subjects (CT). For determination of IL-12 and CXCL-10 with Multiplex®-MERCK©. Statistical analysis by SPSS V.22 using U de Mann Whitney, p

Introduction and Objectives: The clinical alterations of Minimal Hepatic Encephalopathy (MHE) include subtle changes in cognitive processes detectable only with tests such as the Psychometric hepatic encephalopathy score (PHES) and critical blink rate (FCP) or P300 cognitive evoked potentials. After treatment with L-Ornithine, L-Aspartate (LOLA) 18 grams/30 days, a decrease or normalization in the PHES score, an increase in FCP, and a reduction in the latency of the P300 potential have been observed. In the short term, it is unknown if there are changes in these three indicators of the cognitive status of patients with MHE. This study aimed to detect changes in the potential cognitive P300 of patients treated with LOLA 18g/3 days. Materials and Methods: Cirrhotic patients who attended the Liver Clinic of the Gastroenterology Service of the General Hospital of Mexico ''Eduardo Liceaga'' were included. The PHES test and FCP were applied, and the electroencephalogram (EEG) was recorded while visual stimuli were presented in a cognitive task to obtain the potential P300. The criteria for MHE were a PHES test score of less than -4 standard deviations (sd) and an FCP score of less than 39.0 Hz. EHM patients were given LOLA 6g/3 times a day for three days. Subsequently, the PHES, FCP, and P300 tests were repeated. Results: 89 patients with liver cirrhosis participated, 54 women (60.7%) with 53±7.9 years of age and 8.3±3.4 years of schooling. Fifty-seven patients (64.0%) were positive for PHES and 64 were positive for FCP (71.9%). EHM (positive for PHES and FCP) was detected in 53 patients (59.6%). Thirty-six patients (68%) accepted treatment with LOLA or completed the three tests, of which 16 repeated the three tests. The median PHES before treatment was -5.0 ds(-1,-6) and after treatment with LOLA -3.0 ds(-2,-4). The difference was significant in the Wilcoxon test for paired samples p

Introduction and Objectives: Among the WHO, goals for 2030 are to detect >90% of people with HCV and link >80% to treatment. Our institution serves an open population without social security. This study aimed to describe the detection strategy that was carried out in the open population, using two-step HCV detection tests at “Hospital General de México” from January to December 2021. Materials and Methods: The study was conducted in an open population that transits for our hospital for any reason and agreed to take the risk factor questionnaire and the rapid test for the detection of anti-HCV antibodies (RT); those who were reactive underwent viral load (PCR to detect HCV-RNA). Descriptive statistics and the statistical package STATA v.14 were used. Results: In 2021, 33,523 subjects were screened; 71.5% were women, mean age of 47±10 years. Reported at least one risk factor for HCV 53.5%. The most frequent risk factors were: Multiple sexual partners (MSP)/sexually transmitted diseases (STDs) 36.2%, tattoos/piercings 26.7%, surgery before 1995 20.2%, transfusion before 1994 5.4%, health workers after accidental puncture 4.2%. Of the 33,523, 0.7% were reactive in the RT; of them, the PCR was positive in 57.9% (prevalence of viremia= 0.4%). Among the viremic, the risk factors identified were: blood transfusion before 1995 37%, MSP/STDs 35%, surgery before 1995 30%, tattoos/piercings 30%, and drugs 3.5%. Of all viremic, 134 (100%) were linked to attention at the Mexican health sector; 114 (85.1%) without insurance treated at our hospital; 89 (78%) received DAAs at our institution in 2021 and have completed the time to assess SVR12, per protocol the SVR12 rate was 97.7% (2 failures), by intention to treat SVR12 was 93.2% (2 failures, 1 missing, three deaths from COVID-19). The remaining 25 patients detected in 2021 (22%) and without eligibility continued the protocol for treatment with DAAs during the year 2022. Conclusions: The prevalence of HCV was similar to that previously reported. Traditional risk factors such as transfusion or surgery are still very prevalent. Timely diagnosis of HCV allows treatment to be linked to an optimal level of SVR12 in accordance with the WHO goals.

Introduction and Objectives: Albumin is administered to prevent post-paracentesis circulatory dysfunction syndrome (CDS). In many cases, this costly resource is not available. A previous study evaluated the use of norepinephrine in the prevention of CDS with promising results (Singh V et al. J Intern Med. 2006;260(1):62-68.). This study aimed to describe the results obtained in a group of cirrhotic patients with grade III ascites who, due to lack of albumin, were administered norepinephrine infusion as an alternative in post-paracentesis ≥5L. Materials and Methods: A prospective, descriptive and analytical study was carried out, including cirrhotic patients with grade III ascites who were administered norepinephrine to prevent CDS. Those with infection, baseline kidney injury, recent alcohol consumption and digestive tract bleeding were excluded. Descriptive statistics were performed, with measures of central tendency and dispersion, and the inferential analysis was performed comparing creatinine, NGAL, cystatin C, and sodium at days 0, 3, 6 and 28. It was evaluated if there was development of CDS. Results: 12 patients were included; one presented chest pain without electrocardiographic changes, associated with an increased accidental rate of the infusion (norepinephrine was discontinued); therefore, 11 patients were analyzed; 9(81.8%) men; median age 52.2(range: 39-68) years; 9(81.8%) Child C and 2(18.2%) B; regarding the etiology 8(72.7%) due to alcohol, 2(18.2%) MAFLD, 1(9.1%) HCV. The time in years from the diagnosis of cirrhosis was: 4 (36.4%) less than one year, 6 (54.5%) 1 to 5 years, and 1 (9.1%) more than six years. The median ascites drained was 12.5 L (range: 9-18); the median cost with albumin 8g/L of this drain was $400 USD ($288-576 USD); the cost of the norepinephrine strategy of 2 (2-4 ampoules) with an estimated cost of $12 USD ($12-24 USD). Nobody developed encephalopathy, kidney injury, or CDS. There was no difference between the values ​​determined on days 0, 3, 6 and 28 (p=NS). The results of renal function parameters and renal injury markers are shown in the graphs. Conclusions: Norepinephrine appears to be a cost-effective alternative where albumin is not available to prevent CDS. Security seems optimal, but trained personnel are required to handle it.

El estreñimiento crónico (EC) es una condición común que afecta a la población mundial (12 al 19%), con una mayor predilección por las mujeres, con una proporción estimada M: H de 2.2:1.

COVID-19 is mainly a respiratory illness caused by the SARS-CoV-2 but can also lead to GI symptoms. The primary host receptor which mediates the mechanism as SARS-CoV-2 enters the cell is the ACE2 receptor. Therefore, GI symptoms can be common in COVID-19, and in some cases, they are the first manifestation even before fever and respiratory symptoms. In addition, the liver function tests alteration often is related to a worse prognosis. The exact incidence of GI symptoms is a matter of debate. Moreover, wide variation concerning GI symptoms frequency exists, but the predominant ones seem to be diarrhea, anorexia, nausea, vomiting, and abdominal pain or discomfort. This review summarizes the most relevant findings of COVID-19 on the digestive system, including the liver, biliary tract, pancreas, the most common GI symptoms, and the atypical clinical GI manifestations.

Background and aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the current pandemic, can have multi-organ impact. Recent studies show that liver injury could be a manifestation of the disease, and that liver disease could also be related to a worse prognosis. Our aim was to compare the characteristics of patients with severe coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 who required intubation versus stable hospitalized patients to identify the early biochemical predictive factors of a severe course of COVID-19 and subsequent requirement for intubation, specifically in Mexican. Methods: This was an observational case-control study nested in a cohort study. Complete medical records of patients admitted for confirmed COVID-19 at a tertiary level center in Mexico City were reviewed. Clinical and biochemical data were collected, and the characteristics of patients who required invasive mechanical ventilation (IMV) (cases) were compared with stable hospitalized patients without ventilation (controls). Results: We evaluated 166 patients with COVID-19 due to SARS-CoV-2 infection; 114 (68.7%) were men, the mean age was 50.6 ± 13.3 years, and 27 (16.3%) required IMV. The comparative analysis between cases and controls showed (respectively) significantly lower blood oxygen saturation (SpO2) (73.5 ± 12.0% vs. 83.0 ± 6.8%, P

Introduction and Objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results: Overall, 4.6% (CI 3.7–5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14−25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P 30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P

Introduction and Objectives: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the impact of SARS-CoV-2 infection on clinical outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results: Overall, 4.6%(CI 3.7-5.6) subjects had cirrhosis (n=96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis compared to 16% in those without cirrhosis (P30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P

Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS); however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1; P=0.003), AST 325.3±382.4 vs. 52.8±47.1; P=0.001), LDH (764.6±401.9 vs. 461.0±185.6; P=0.001), D dimer (7765±9109 vs. 1871±4146; P=0.003), age (58.6±12.7 vs. 49.1±12.8; P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV; with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86; P

Introduction & objectives: The independent effect of liver biochemistries as a prognostic factor in patients with COVID-19 has not been completely addressed. We aimed to evaluate the prognostic value of abnormal liver tests on admission of hospitalized patients with COVID-19. Materials & methods: We performed a prospective cohort study including 1611 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through July 31, 2020 in 38 different Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters, including liver function tests, on admission and during hospitalization. All patients were followed until discharge or death. We fit multivariable logistic regression models, further post-estimation effect through margins and inverse probability weighting. Results: Overall, 57.8% of the patients were male with a mean age of 52.3 years, 8.5% had chronic liver disease and 3.4% had cirrhosis. Abnormal liver tests on admission were present on 45.2% (CI 42.7–47.7) of the cohort (n = 726). Overall, 15.1% (CI 13.4–16.9) of patients died (n = 244). Patients with abnormal liver tests on admission presented higher mortality 18.7% (CI 15.9–21.7), compared to those with normal liver biochemistries 12.2% (CI 10.1–14.6); P 30. Conclusions: The presence of abnormal liver tests on admission is independently associated with mortality and severe COVID-19 in hospitalized patients with COVID-19 infection and may be used as surrogate marker of inflammation. Clinicaltrials.gov: NCT04358380.

Introduction: Variceal bleeding (VB) is a serious complication in cirrhotic patients. Hepatic pressure venous gradient (HPVG) is the gold standard to assess high risk of VB, but, this is not always available and is an invasive method. Therefore is necessary to explore if non-invasive parameters are useful as predictive factors of high risk of VB. Objective: To evaluate if low platelet count, spleen size, platelet count/spleen size ratio, portal vein diameter, blood flow velocity of the portal vein, congestion index of the portal vein, and variceal size could be useful as non-invasive parameters for predicting high risk of VB in cirrhotic patients. Subjects and methods: Observational, cross sectional study, that includes 99 cirrhotic patients with esophageal varices. For predictive analysis we considered as the dependent variable “presence of VB” and the independent variables we tested were: Child-Pugh score, platelet count, spleen size, portal vein diameter, platelet count/spleen size ratio, blood flow velocity of the portal vein, congestion index of the portal vein, variceal size. Univariate and multivariate logistic regression were performed. Results: 99 cirrhotics with esophageal varices were included, 56 (56.6%) were female, the mean of age was 57.8 ± 12.2. About variceal size, 54 (54.5%) of patients had large varices. Regarding to occurrence of VB, 46 (46.5%) presented it. In the multivariate analysis, the presence of large varices in the endoscopic study was the best predictor of VB (OR = 11.1; 95% CI = 3.9 to 32.8, P

Background: Severe alcoholic hepatitis (SAH) presents high early mortality-rate (90 days) and is related to several complications. The aim of this study was to evaluate the impact on early mortality-rate of developed complications in patients with SAH, and to evaluate the accuracy of different prognostic scoring systems to predict early mortality. Subjects and methods: Cohort study. Were included 110 patients with SAH. We collected data about development of complications: acute renal failure (ARF), hepatic encephalopathy (HE), variceal bleeding (VB), infections; alcohol intake (g/day) and presence of cirrhosis by ultrasonography (USG). Child-Pugh, Maddrey's modified discriminant function (DF), Model for End stage Liver Disease (MELD); Age, Bilirubin, INR, and Creatinine score (ABIC); Lille score, and Glasgow Alcoholic Hepatitis Score (GAHS) were calculated. Primary endpoint was 90-day mortality. To evaluate survival according to the development of complications we performed a Cox regression model. Accuracy of different prognostic scoring systems was evaluated trough ROC curves. Results: 90-day mortality-rate was 71 patients (64.5%). 79 patients (71.8%) had evidence of cirrhosis in the USG, 59 (53.6%) developed HE, 54 (49.1%) ARF, 41 (37.3%) VB, and 41 (37.3%) infection. In the Cox-regression model significant association was found between greater risk of mortality and the development of HE (HR 8.0; IC al 95% 3.0 a 21.4; P = 0.0001) and presence of cirrhosis in the USG (HR 3.0; 95% CI 1.0 to 8.7; P = 0.045). Regard to prognostic scoring systems we found that Lille score ≥ 0.45 was the best predictor of early mortality in patients with SAH (AUROC = 0.83; 95% CI 0.75 to 0.91, P

Background & Aim. Despite treatment with glucocorticoids, mortality remains high in patients with severe alcoholic hepatitis. Oxidative stress and depletion of mitochondrial glutathione are implicated factors in liver injury. The aim of this study was to evaluate the impact of the addition of metadoxine, a drug which possesses a multifactorial mechanism of action, including antioxidant properties, to standard treatment with glucocorticoids in patients with severe alcoholic hepatitis.Material and methods. This randomized open label clinical trial was performed in Mexico’s General Hospital (Registry Key DIC/10/107/03/043). We randomized 70 patients with severe alcoholic hepatitis. The first group received prednisone (40 mg/day), and the second group received prednisone (40 mg/day) plus metadoxine tablets (500 mg three times daily). The duration of treatment in both groups was 30 days. Survival at 30 and 90 days, development of complications, adverse events and response to treatment (Lille model) were assessed.Results. In the group receiving metadoxine, significant improvements were observed, as follows: survival at 30 days (74.3 vs. 45.7%, P = 0.02); survival at 90 days (68.6 vs. 20.0%, P = 0.0001). There was less development or progression of encephalopathy (28.6 vs. 60.0%, P = 0.008) and hepatorenal syndrome (31.4 vs. 54.3%, P = 0.05), and the response to treatment (Lille model) was higher in the metadoxine group (0.38 vs. 0.63, P = 0.001; 95% CI 0.11 to 0.40). There were no differences between groups regarding the development or progression of variceal hemorrhage or infection. The incidence of adverse events, mainly gastrointestinal, was similar in both groups.Conclusions. Addition of metadoxine to glucocorticoid treatment improves the short-term survival of patients with severe alcoholic hepatitis and diminishes the development or progression of encephalopathy and hepatorenal syndrome.

ABSTRACT BACKGROUND: Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. OBJECTIVE: To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. METHODS: An observational, retrospective, historic cohort study. The exposed cohort included patients with cirrhosis with chronic use of PPI. The non-exposed cohort had not been using PPI. The follow-up period was 3 years, searching in the medical records for any events of bacterial infection confirmed by bacteriological culture. RESULTS: One hundred and thirteen patients met the selection criteria, 44 (39%) had chronic use of PPI; of them, 28 (63.6%) patients had not a clear clinical indication to justify the prescription of PPI. Twenty four (21.2%) patients developed bacterial infections during the follow-up period. In the univariate analysis, decompensated cirrhosis (Child B/C), presence of ascites, history of variceal bleeding, and chronic consumption of PPI were risk factors related to the development of infections. But, in the adjusted multivariate analysis only the chronic use of PPI was associated with development of infections (RR=3.6; 95% CI=1.1-12.3; P=0.04). CONCLUSION: There is an over-prescription of PPI without a justified clinical indication. The long-term consumption of PPI in patients with cirrhosis is associated with the development of bacterial infections; therefore these drugs must be carefully prescribed in this specific population.

Background: Nonalcoholic fatty liver disease (NAFLD) is a serious worldwide health problem, with an estimated global prevalence of 24%; it has a notable relationship with other metabolic disorders, like obesity and type 2 diabetes mellitus (T2DM). Nonalcoholic steatohepatitis (NASH) is one of the most important clinical entities of NAFLD, which is associated with an increased risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Mexico is one of the countries with the highest prevalence of metabolic diseases; therefore, we sought to investigate the impact that these clinical entities have in the progression to advanced fibrosis in Mexican patients with NASH. Methods: We performed a multicenter retrospective cross-sectional study, from January 2012 to December 2017. A total of 215 patients with biopsy-proven NASH and fibrosis were enrolled. NASH was diagnosed according NAS score and liver fibrosis was staged by the Kleiner scoring system. For comparing the risk of liver fibrosis progression, we divided our sample into two groups. Those patients with stage F0-F2 liver fibrosis were included in the group with non-significant liver fibrosis (n=178) and those individuals with F3-F4 fibrosis were included in the significant fibrosis group (n=37). We carried out a multivariate analysis to find risk factors associated with liver fibrosis progression. Results: From the 215 patients included, 37 had significant liver fibrosis (F3-4). After logistic regression analysis T2DM (p=0.044), systemic arterial hypertension (p=0.014), cholesterol (p=0.041) and triglycerides (p=0.015) were the main predictor of advanced liver fibrosis. Conclusions: In a Mexican population, dyslipidemia was the most important risk factor associated with advanced liver fibrosis and cirrhosis.

Resumen INTRODUCCIÓN Los inhibidores de la bomba de protones son la terapia médica más efectiva para la enfermedad de reflujo gastroesofágico, pero su inicio de acción puede ser lento. OBJETIVO Evaluar la literatura referida a la eficacia del omeprazol y bicarbonato de sodio en la enfermedad por reflujo gastroesofágico. MÉTODOS Revisión sistemática de la literatura desde el año 2000. Se revisaron los manuscritos relativos a la efectividad del tratamiento de la enfermedad por reflujo gastroesofágico. Se extrajo la información relevante, la cual fue subsecuentemente analizada con estadística descriptiva. RESULTADOS Se incluyó información de cuatro estudios. Dos estudios compararon la eficacia de omeprazol y bicarbonato de sodio versus omeprazol, y un estudio comparó la eficacia de la dosis diaria matutina con la nocturna. El otro estudio comparó omeprazol más bicarbonato de sodio y alginato versus omeprazol. No hubo diferencia entre omeprazol con bicarbonato de sodio y omeprazol. Sin embargo, hubo una tendencia hacia una respuesta más sostenida y una mayor proporción de alivio total sostenido por 30 minutos con omeprazol y bicarbonato de sodio. CONCLUSIÓN La terapia con omeprazol y bicarbonato de sodio no es más efectiva que el omeprazol en el tratamiento de la enfermedad por reflujo gastroesofágico. Sin embargo, la información sugiere que puede tener una respuesta más sostenida y un alivio total de mayor duración.