2017年 · 第37卷第08期

With the development of medicine, the understanding of diseases is constantly improved and improved. Some so-called rare diseases in the past have obviously increased their incidence or have become common diseases. For clinicians, they have also experienced the process of many diseases from not recognizing them, from lack of experience in diagnosis and treatment to accumulating rich experience. In this process, many physicians have gradually grown and improved "under the guidance of consensus and/or guidelines". With the development of basic research and clinical research, the consensus and/or guidelines for the diagnosis and treatment of many diseases are constantly promulgated or updated, which is very important for guiding doctors' clinical work!

hepatic encephalopathy is a neuropsychiatric syndrome of varying severity, which is caused by acute and chronic severe liver function disorders or various abnormalities of portal-systemic circulation shunt, and is based on metabolic disorders. minimal hepatic encephalopathy (MHE) often has no obvious clinical symptoms and can only be detected by neuropsychological tests. The development of medical science is a process of moving forward in contradictions. When disease development conflicts with the current status of treatment, new clinical needs are formed, and the same is true of hepatic encephalopathy. Due to the complexity of hepatic encephalopathy and the lack of effective diagnosis and treatment methods, clinical understanding is incomplete, and hepatic encephalopathy is even regarded as a pathological state that only appears in the end-stage liver disease. There is a big gap between practice and guidelines. According to a survey of members of the American Association for the Study of Liver Diseases (AASLD), 84% of respondents believe that MHE is important, 74% believe that MHE should be diagnosed, but 38% of physicians have never diagnosed MHE patients^[1]。 Starting from the historical point of view and practical needs of hepatic encephalopathy, this paper expounds how to correctly understand the definition and classification of hepatic encephalopathy, and the diagnosis and treatment requirements that clinicians should meet in practice.

hepatic sinusoidal obstruction syndrome (HSOS), also known as hepatic veno-occlusive disease (HVOD), is a liver vascular disease caused by various causes of edema, necrosis and shedding of endothelial cells of hepatic sinuses, hepatic venules and interlobular veins, which then form microthrombi, causing intrahepatic congestion, liver function damage and portal hypertension^[1,2,3,4]。 In 2002, DeLeve et al.^[5]Based on experimental and pathological findings, it is recommended to replace HVOD with HSOS. Both of these names have been used in the literature published in recent years. Therefore, this consensus agrees that HSOS and HVOD can be substituted for each other^[6]。

Liver cirrhosis is a common chronic disease in China, which seriously endangers people's health and life. How to accurately assess the severity and prognosis of patients with liver cirrhosis has been the focus of clinical work. Cross et al.^[1]It is proposed that the liver to abdominal area ratio (LAAR) can be calculated by selecting the cross section with the largest liver area in the CT images of patients with end-stage liver disease undergoing abdominal CT examination, which can accurately predict the prognosis of patients. At present, there are few reports of LAAR in evaluating the prognosis of patients with end-stage liver disease in China, so this study aims to evaluate the accuracy of LAAR in predicting the prognosis of patients with decompensated cirrhosis at 3 months and 1 year, and compare it with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD).

Cirrhosis is the terminal stage in the development of various chronic liver diseases. Liver cirrhosis caused by hepatitis B or C is more common in China, while in European and American countries, it is mostly caused by chronic ethanol poisoning caused by long-term heavy drinking. At present, with the increasing incidence of liver cirrhosis, it has caused a great impact on the health of our people.

Cirrhosis is a common chronic progressive liver disease in clinic. It is a diffuse liver injury formed by one or more etiologies for a long time or repeated action. In the advanced stage, portal hypertension can occur. When the portal pressure increases to a certain extent, esophageal and gastric varices can occur, and in severe cases, varicose vein rupture and bleeding can occur. Therefore, early knowledge of the severity of esophagogastric varices can reduce the risk of varicose vein rupture caused by gastroscopy or other invasive examinations. Non-invasive serological diagnostic models are diagnostic models established from a combination of serum biomarkers. Recent studies have confirmed that aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on 4 factor (FIB-4), S Index can be used to assess liver cirrhosis^[1,2]However, its predictive value for cirrhotic esophageal varices is rarely reported. Therefore, this study aimed to explore the predictive value of a noninvasive serological diagnostic model of liver fibrosis for esophageal varices in cirrhosis.

On July 15, 2017, the 4th Oriental Congress of Digestive Disease (OCDD) was successfully held at Shanghai International Convention Center. This conference was jointly sponsored by six specialty branches, including Shanghai Medical Association Gastroenterology Branch, Shanghai Medical Association Digestive Endoscopy Branch, Shanghai Medical Association Hepatology Branch, Shanghai Medical Association Infectious Diseases Branch, Shanghai Medical Association General Surgery Branch and Shanghai Esophagogastric Varices Branch, with a total of more than 1,000 registered representatives. It is a large-scale academic event with first-class academic level in Shanghai's gastroenterology community.

Esophageal stenosis often starts with dysphagia and has a variety of causes. More common, such as GERD, are complications caused by long-term acid reflux. In addition to GERD, there are many other causes, such as systemic sclerosis, Zollinger-Ellison syndrome, infectious esophagitis, esophageal cancer, corrosive esophagitis, radiation exposure, etc., which can lead to esophageal stenosis. epidermolysis bullosa (EB) is a rare genetic disease, most of which occur in infants and young children, and the complications of esophageal stenosis caused by it are even less common, which is difficult to attract the attention of gastroenterologists. The data of a case of EB with esophageal stricture as the main manifestation in Peking Union Medical College Hospital were retrospectively analyzed, and its diagnosis and treatment were discussed.

A 64-year-old male was admitted to Linyi People's Hospital on November 7, 2015 due to abdominal pain for 0.5 d and bloody stool for 2 h. The patient's abdominal pain was persistent dull pain without obvious intermittent period, and paroxysmal aggravation. When the pain aggravated, it was colic, which was not related to body position and diet. There was no radiating pain in the back and shoulder, no fever, no nausea, vomiting, no palpitation, chest tightness, no headache, dizziness, and blood stools were discharged once after about 40 minutes, with a amount of about 200 g, and he was admitted as "gastrointestinal bleeding". He had a history of cerebral infarction for 2 years, had colonic polypectomy 2 years ago, smoked for more than 40 years, about 20 cigarettes/d, and drank alcohol for 30 years, about 500 mL/d. Physical examination on admission: vital signs stable, clear consciousness, poor spirit, moderate anemia, soft abdomen, tenderness in the upper abdomen, no rebound pain, no abdominal mass, no subcostal reach of liver and spleen, unpalpable gallbladder, negative Murphy's sign, existence of liver turbidity, and no positive signs. Laboratory test: Routine blood RBC count was 2.64×10¹²/L, Hb was 77 g/L, fecal occult blood test was positive, blood amylase was 100.9 U/L, blood biochemical indexes, tumor markers and coagulation function were not abnormal. To routine medical treatment. Total abdominal CT (plain scan + enhanced) and total abdominal CT angiography showed that the body of the pancreas lacked blood supply, and the body of the pancreas occupied space with peripancreatic exudative changes, and the distal end of the main pancreatic duct of the pancreas was dilated; The wall of gastric antrum is slightly thicker; atherosclerotic changes; Calcification of the prostate; SeeFigure 1。 On the second day of admission, the patient's abdominal pain was relieved, and he did not defecate any more bloody stool, so he continued the conventional medical treatment regimen. In order to clarify the cause of blood in the stool, electronic colonoscopy was performed, and a bleeding spot was seen in the ileocecal region, which was clipped with a titanium clip; A flat polyp with a maximum diameter of about 0.3 cm was seen in the ascending colon, which was removed by hot biopsy forceps; No abnormalities were observed in the remaining colorectum. After that, the patient did not have abdominal pain or bloody stool again during hospitalization, and the possibility of other gastrointestinal bleeding was not ruled out. Further capsule endoscopy showed chronic gastritis with bulge, erosion and small intestinal inflammatory reaction. Because the patient had blood in the stool again, the gastroscopy was re-examined, and no bleeding was seen. The diagnosis was chronic atrophic gastritis with erosion, gastric lesions (hemorrhagic disease to be discharged), and esophageal erosion? The patient was discharged on 21 Nov 2015 after improvement.

Portal vein thrombosis refers to the formation of thrombosis in the main portal vein and its branches of portal vein system, which is one of the important complications of liver cirrhosis^[1]。 In recent years, with the improvement of clinical diagnosis and treatment technology and in-depth research on this disease, patients with liver cirrhosis accompanied by portal vein thrombosis have been paid more and more attention by clinicians. The progress in the epidemiology, pathogenesis, natural history, diagnosis, prevention and treatment of portal vein thrombosis in liver cirrhosis in recent years is summarized.

Hepatic fibrosis is a common pathological stage in the development of various chronic liver diseases. Accurate assessment of the degree of liver fibrosis is helpful for its early diagnosis and treatment, and it is of great significance to delay the progression of liver fibrosis and improve the prognosis. Liver histopathological examination is the gold standard for diagnosing liver fibrosis and judging its degree. However, because liver puncture is an invasive examination, and it cannot dynamically observe the changes of patient's condition and evaluate the therapeutic effect, it has been limited in clinical application. Therefore, exploring noninvasive detection indexes of liver fibrosis has been a hot spot in clinical research. Wisteria agglutinin (Wisteria floribundaagglutinin (WFA) -positive Mac-2-binding protein (M2BP) is a novel serum glycoprotein detection index using WFA to detect the changes of sugar chains on the protein surface. It may be a non-invasive, reliable and simple marker of liver fibrosis. The application status of WFA positive M2BP in the diagnosis and treatment of chronic liver disease is reviewed.

IL-22 is a newly discovered immune mediator, which has attracted much attention in the field of liver disease research in recent years. IL-22 has anti-inflammatory and pro-inflammatory roles in the progression of liver diseases, and its ultimate role depends on many factors such as local inflammatory microenvironment, cytokine concentration and action time of liver. The possible mechanisms of action of IL-22 in some liver diseases are summarized below.