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Aims To examine the temporal changes of both controlled attenuation parameter (CAP) and liver stiffness measurements (LSM), assessed by Fibroscan, in a large sample of patients with non-alcoholic fatty liver disease (NAFLD). Methods In this prospective, observational study, we consecutively enrolled 507 adult individuals with Fibroscan-defined NAFLD who were followed for a mean period of 21.2 ± 11.7 months. Results During the follow-up period, 84 patients (16.5%) had a progression of CAP of at least 20% with a median time of 39.93 months, while 201 (39.6%) patients had a progression of LSM of at least 20% with median time of 30.46 months. There were significant differences in the proportion of LSM progression across body mass index (BMI) categories, with obese patients having the highest risk of progression over the follow-up (hazard ratio 1.66; 95%CI 1.23–2.25). Multivariable regression analysis showed that BMI and serum creatinine levels were the strongest predictors for CAP progression in the whole population, while HOMA-estimated insulin resistance was an independent predictor of LSM progression over time in the subgroup of obese patients. Conclusion This prospective study shows for the first time that the progression risk of both liver steatosis and fibrosis, detected non-invasively by Fibroscan, is relevant and shares essentially the same metabolic risk factors that are associated with NAFLD progression detected by other invasive methods.

To explore the effect of nonalcoholic fatty liver as a hepatic manifestation of metabolic syndrome on the severity of acute pancreatitis. We hypothesized that patients with nonalcoholic fatty liver would have a more severe form of acute pancreatitis.We retrospectively analyzed 822 patients hospitalized with acute pancreatitis. We diagnosed acute pancreatitis and determined its severity according the revised Atlanta classification criteria from 2012. We assessed nonalcoholic fatty liver with computed tomography.There were 198 (24.1%) patients out of 822 analyzed who had nonalcoholic fatty liver. Patients with nonalcoholic fatty liver had statistically higher incidence of moderately severe (35.4% vs. 14.6%; p=0.02) and severe acute pancreatitis (20.7% vs. 9.6%; p0.001) compared to patients without nonalcoholic fatty liver. At the admission patients with nonalcoholic fatty liver had higher values of C-reactive protein as well as at day three, higher APACHE II score at admission and significantly higher incidence of organ failure and local complications as well as higher values of computed tomography severity index compared to patients without nonalcoholic fatty liver. We found independent association between the occurrence of moderately severe and severe acute pancreatitis and nonalcoholic fatty liver (OR 2.13, 95%CI 1.236-3.689). Compared to patients without nonalcoholic fatty liver, patients with nonalcoholic fatty liver had a higher death rate, however not statistically significant (5.6% vs. 4.3%; p=NS).Presence of nonalcoholic fatty liver at admission can indicate a higher risk for developing more severe forms of acute pancreatitis and could be used as an additional prognostic tool.

We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z-score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of -2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points-lumbar spine (anteroposterior orientation from L1-L4) and hip (neck, trochanter, intertrochanter, total and Ward's triangle)-and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of -1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.

Nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) is a challenging and multisystem disease that has a high socioeconomic impact. NAFLD/ NASH is a main cause of macrovesicular steatosis and has multiple impacts on liver transplantation (LT), on patients on the waiting list for transplant, on posttransplant setting as well as on organ donors. Current data indicate new trends in the area of chronic liver disease. Due to the increased incidence of metabolic syndrome (MetS) and its components, NASH cirrhosis and hepatocellular carcinoma caused by NASH will soon become a major indication for LT. Furthermore, due to an increasing incidence of MetS and, consequently, NAFLD, there will be more steatotic donor livers and less high quality organs available for LT, in addition to a lack of available liver allografts. Patients who have NASH and are candidates for LT have multiple comorbidities and are unique LT candidates. Finally, we discuss long-term grafts and patient survival after LT, the recurrence of NASH and NASH appearing de novo after transplantation. In addition, we suggest topics and areas that require more research for improving the health care of this increasing patient population.

One of the least studied topics in the field of obstetrics is liver disease during pregnancy, which creates a challenge for both gynecologists and hepatologists. Approximately 3% of pregnant women are affected by some form of liver disease during pregnancy. Some of these conditions can be fatal for both the mother and child. In addition, 3 types of liver disease need to be differentiated during pregnancy. One type is liver disease directly related to pregnancy, which can occur at a specific time during pregnancy. Another type is liver disease not related to pregnancy, which can occur at any time, such as viral- or drug-induced hepatitis. Furthermore, pregnancy can occur in women with pre-existing liver disease. It is essential that the clinicians are familiar with this disorder so they can respond promptly and appropriately in all of these situations, especially when emergency delivery is needed and must not be postponed.

As a significant cause of cancer death worldwide, colorectal cancer (CRC) is still one of the most common cancers in the world. The most efficient strategies to reduce CRC incidence include identifying risk factors for CRC and performing a preventive colonoscopy in high-risk populations. Some well-established risk factors for CRC development include hereditary syndromes and inflammatory bowel disease. Of note, in recent years, attention has been given to new evidence indicating that more than 75%–95% of CRC occurs in individuals with little or no genetic risk. For these individuals, the risk for CRC is associated with their lifestyle and dietary factors, including central obesity, overweight and physical inactivity. Recently, evidence demonstrated a connection between non-alcoholic fatty liver disease (NAFLD) and CRC. Insulin resistance and metabolic syndrome (MetS) are common risks that NAFLD and colorectal neoplasms share. The incidence of NAFLD is increasing in parallel with an increasing prevalence of MetS and obesity. Consequently, the question arises: will the incidence of CRC increase together with this dramatic increase in obesity, MetS and ultimately NAFLD prevalence? Recent studies of adenomatous polyps, CRC and NAFLD are discussed in this manuscript.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common comorbidities associated with overweight and metabolic syndrome (MetS). Importantly, NAFLD is one of its most dangerous complications because it can lead to severe liver pathologies, including fibrosis, cirrhosis and hepatic cellular carcinoma. Given the increasing worldwide prevalence of obesity, NAFLD has become the most common cause of chronic liver disease and therefore is a major global health problem. Currently, NAFLD is predominantly regarded as a hepatic manifestation of MetS. However, accumulating evidence indicates that the effects of NAFLD extend beyond the liver and are negatively associated with a range of chronic diseases, most notably cardiovascular disease (CVD), diabetes mellitus type 2 (T2DM) and chronic kidney disease (CKD). It is becoming increasingly clear that these diseases are the result of the same underlying pathophysiological processes associated with MetS, such as insulin resistance, chronic systemic inflammation and dyslipidemia. As a result, they have been shown to be independent reciprocal risk factors. In addition, recent data have shown that NAFLD actively contributes to aggravation of the pathophysiology of CVD, T2DM, and CKD, as well as several other pathologies. Thus, NAFLD is a direct cause of many chronic diseases associated with MetS, and better detection and treatment of fatty liver disease is therefore urgently needed. As non-invasive screening methods for liver disease become increasingly available, detection and treatment of NAFLD in patients with MetS should therefore be considered by both (sub-) specialists and primary care physicians

The aim of our study was to investigate the influence of metabolic syndrome on the course of acute pancreatitis determined by disease severity, the presence of local and systemic complications and survival rate. 609 patients admitted to our hospital in the period from January 1, 2008 up to June 31, 2015 with the diagnosis of acute pancreatitis were analyzed. The diagnosis and the severity of acute pancreatitis were made according to the revised Atlanta classification criteria from 2012. Of 609 patients with acute pancreatitis, 110 fulfilled the criteria for metabolic syndrome. Patients with metabolic syndrome had statistically significantly higher incidence of moderately severe (38.2% vs. 28.5% ; p=0.05) and severe (22.7% vs. 12.8% ; p=0.01) acute pancreatitis in comparison to those without metabolic syndrome, while patients without metabolic syndrome had higher incidence of mild acute pancreatitis in comparison to those patients with metabolic syndrome (58.7% vs. 39.1% ; p

Inhibitori protonske pumpe (IPP) lijekovi su koji su u potpunosti promijenili način liječenja stanja povezanih s pojačanim lučenjem želučane kiseline; peptički ulkus, gastroezofagealna refluksna bolest, funkcionalna dispepsija, gastroprotekcija. Iako su IPP-ovi široko propisivani lijekovi, posljednjih godina povećana pozornost posvećena je potencijalnim neželjenim učincima ovih lijekova. S obzirom na to da sve veći broj pacijenata prima IPP-ove kao dio kronične terapije za bolesti i stanja koja su povezana s pojačanim lučenjem želučane kiseline, dugoročni potencijalno štetni učinci ove skupine lijekova dobivaju sve veću pozornost, pri čemu većina istraživanja upućuje na to da su određeni pacijenti u skupini s povećanim rizikom., Proton pump inhibitors (PPI) are the drugs that have brought a revolution as a treatment of choice for various conditions associated with increased secretion of gastric acid; peptic ulcers, gastroesophageal reflux disease, functional dyspepsia. Although PPIs are widely prescribed and generally safe drugs, recently increased attention was focused on the potential adverse effects of these drugs. Given the increasing number of patients receiving PPI’s, long-term potential adverse effects of this class of drugs are gaining increasing attention. However, most of recent investigations raise the possibility that elderly and malnourished patients have a higher risk for these side effects.

Uvod: Utvrditi povezanost između controlled attenuation parameter (CAP) kao elastografskog parametra steatoze jetre i jetrene tvrdoce (liver stiffness measurements ; LSM) kao elastografskog parametra fibroze definiranih metodom tranzijetne elastografije (TE) i razlicitih klinickih i biokemijskih parametrima kod bolesnika s jednom ili vise komponenti metabolickog sindroma (MetS). Nasa hipoteza je da arterijska hipertenzija (AH) utjece na fibrozu jetre vise od drugih MetS komponenti. Pacijenti i metode: U ovo presjecno istraživanje ukljucili smo 648 bolesnika u razdoblju od 2013. do 2015. godine. Temeljem klinickih i laboratorijskih parametara iskljucene su druge etiologije kronicne bolesti jetre. Znacajna steatoza jetre definirana je vrijednostima CAP-a ≥ 238 dB/m, a znacajna fibroza vrijednostima LSM-a > 7 kPa. Rezultati: Od 648 bolesnika, 82, 1 % imao je AH, 45, 7 % secernu bolest tip 2 (T2DM), 77, 9 % dislipidemiju, prosjecan opseg struka bio je 103 ± 14 cm, a 67, 3 % bolesnika ispunilo je kriterije za dijagnozu MetS-a. Bolesnici s CAP ≥ 238 dB/m (n = 572) imali su znacajno vecu prevalenciju MetS-a i svih njegovih komponenti u usporedbi s bolesnicima s urednim CAP-om. Bolesnici s CAP ≥ 238 dB/m i LSM > 7, 0 kPa (n = 103) imali su vise vrijednosti jetrenih enzima i vecu prevalenciju MetS-a i svih njegovih komponenti u odnosu na bolesnike s povisenim CAP-om, a urednim LSM-om. Analizirajuci metabolicke parametre, u multivarijatnoj analizi, cimbenici koji su bili nezavisno udruženi s povisenim CAP-om bili su prisustvo MetS-a (i njegove pojedinacne komponente), inzulinska rezistencija (IR) (definirana HOMA-IR bodovnim sustavom) i poviseni urati. Najjacu povezanost s CAP-om pokazala je dislipidemija. Slicno, u multivarijatnoj analizi cimbenici koji su bili nezavisno povezani s povisenim LSM-om bili su MetS (i njegove pojedinacne komponente), IR i poviseni urati. Od svih metabolickih komponenti, najjacu povezanost s povisenim LSM-om pokazala je arterijska hipertenzija (OR 3, 73 ; 95%Cl 1, 57–8, 85 ; p < 0, 005). Zakljucak: Sve komponente MetS-a znacajno su povezane sa CAP-om i LSM-om kao elastografskim parametrima stetaoze i fibroze jetre. Od svih metabolickih komponenti, arterijska hipertenzija ima najveci utjecaj na fibrozu jetre izraženu LSM vrijednostima kod NAFLD bolesnika.