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Volume 76 - 2013 - Fasc.2 - Case series

The endocannabinoid system and its role in the pathogenesis and treatment of cardiovascular disturbances in cirrhosis

It has been known for over half a century that liver cirrhosis is associated with abnormal cardiovascular function. Although the mechanisms underlying the association of portal hypertension and hyperdynamic circulation have been intensively investigated dur- ing the past decades, the results are still inconclusive. This review focuses on the role that the endocannabinoids and their receptors could play in the pathogenesis of the cirrhotic cardiomyopathy, as well as on the treatment options that they offer. (Acta gastroenterol. belg., 2013, 76, 195-199).


Treatment of non-alcoholic fatty liver disease : Can we already face the epidemic ?

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent liver disorder in the Western world. It comprises a disease spec- trum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), which may progress to fibrosis, cirrhosis and its complica- tions like hepatocellular carcinoma and liver failure. In addition, evidence is accumulating that NAFLD is an independent risk factor for cardiovascular diseases. Progress has been made in unraveling the pathogenesis, which paved the way for several clinical trials for the treatment of NAFLD. Life style intervention consisting of in- creased physical activity and dietary modifications, remain the cor- nerstone of the treatment. Some pharmacological agents show promising results, although on the basis of recent clinical trials no firm conclusions can be drawn. Suggestions for treatment in some particular groups of patients can be made. Further research is re- quired to face the burden of NAFLD, which is already present in epidemic proportions. (Acta gastroenterol. belg., 2013, 76, 200-209).


The liver involvement of the hydatid disease : a systematic review designed for the hepato-gastroenterologist

Hydatidosis is not uncommon in Western Europe, mainly due to the presence of immigrants from endemic countries, and hepato- gastroenterologist must then be able to manage this infectious dis- ease. The hepatic hydatidosis is due to development in the liver of the larvae of Echinococcus granulosus that causes liver cysts. It can grow in size throughout the years and can give rise to complica- tions, mainly pain, super-infection or cyst rupture. Recent pro- gresses in imaging modalities play an important role in diagnosis, classification and evaluation of response to treatment of the cysts. Imaging techniques led to both Gharbi's and WHO's classifica- tions. Those can provide markers of cyst activity and can help to determine the best therapeutic strategy. By combining two immu- nodiagnostic techniques, the diagnostic accuracy of laboratory tests is excellent. During the last decade, treatment has improved : the main therapeutic modality in the past was surgery, until the discovery of PAIR procedure (Puncture, Aspiration, Injection, Re-aspiration). Albendazole also plays an important role in the treatment of hydatid cysts either alone or as a pre-procedure or post procedure prophylaxis. This review will cover the major aspects of the disease emphasizing the recent diagnostic and thera- peutic advances. (Acta gastroenterol. belg., 2013, 76, 210-218).