Volume 88 - 2025 - Fasc.4 - Reviews
Chronic hepatitis E in immunosuppressed patients: a comprehensive review of the literature
Hepatitis E virus (HEV) is the commonest cause of acute viral
hepatitis in Western countries, especially genotypes 3 and 4.
Chronic cases are reported in immunosuppressed patients,
which includes patients who have undergone solid organ or stem
cell transplantation, patients who are being treated for cancer or
autoimmune diseases.
Chronic HEV can eventually lead to liver fibrosis,
and exceptional cases requiring liver transplantation for
decompensated liver cirrhosis have been reported.
The mechanisms leading to chronic HEV and its incidence
in the immunosuppressed population is still unclear due to the
paucity of well-designed prospective studies.
According to studies conducted in various European countries,
the HEV seroprevalence in immunocompromised patients ranges
up to 40% and HEV RNA viremic prevalence between 0,5 to 2%.
In this review, we provide a description of the epidemiology,
risk factors and natural history of chronic HEV in relation to
various types of underlying immunosuppressive conditions
and discuss the different treatment options available.
Evaluation of Surgical and Conservative Approaches in the Treatment of Anal Fissure: A Systematic Review
Background and study aims: Anal fissure is a prevalent
condition characterized by severe pain resulting from a tear in
the epithelial layer surrounding the anus. This systematic review
aims to assess the effectiveness of both surgical and conservative
approaches in the management of anal fissures.
Methods: A systematic review was conducted, encompassing
randomized controlled trials (RCTs), quasi-experimental, and
clinical studies published between 2019 and 2024. A comprehensive
literature search was performed in Medline, PubMed, and other
databases using keywords such as ‘anal fissure,’ ‘sphincterotomy,’
and ‘topical treatment.’ The study adhered to the PICOS
framework and followed the PRISMA guidelines. Quality
assessment was conducted using the Joanna Briggs Institute (JBI)
criteria, and a total of 38 studies were included in the analysis.
Results: Of 38 included studies, 27 investigated conservative
treatments and 11 evaluated surgical approaches. Conservative
methods — particularly topical diltiazem and nifedipine,
botulinum toxin injections, and pelvic floor therapy — were
effective in pain reduction and healing for many patients and had
mostly mild adverse effects. Surgical LIS demonstrated superior
long-term healing in refractory cases.
Conclusions: Both surgical and conservative approaches serve
as complementary strategies in the management of anal fissures.
Surgical methods, particularly LIS, provide an effective treatment
option with high success rates, while conservative approaches are
beneficial in the early stages and for specific patient populations.