Objectives: Caffeine consumption is reported to be associated with reduced hepatic fibrosis in patients with chronic liver diseases. We performed a systematic review and meta-analysis to assess the association between caffeine consumption and prevalence or hepatic fibrosis of nonalcoholic fatty liver disease (NAFLD) in observational studies.
Methods:We searched the literature of all languages from PubMed, EMBASE, and the Cochrane library from 1 January 1980 through 10 January 2015. Total caffeine consumption was defined as the daily intake of caffeine (mg/day) from all caffeine-containing products. Combined and subgroup analyses stratified by study designs, study locations, and type of caffeine intake were performed. Results: Four cross-sectional and two case control studies with a total of 20,064 subjects were included in the meta-analysis. Among these, three studies with 18,990 subjects were included in the analysis for prevalence of NAFLD while the other three studies with 1074 subjects were for hepatic fibrosis. Total caffeine consumption (mg/day) was not significantly associated with either the prevalence [pooled mean difference (MD) 2.36; 95% confidence interval (CI) −35.92 to 40.64] or hepatic fibrosis (higher versus lower stages; pooled MD −39.95; 95% CI −132.72 to 52.82) of NAFLD. Subgroup analyses stratified by study designs and locations were also not significant. However, after stratifying by type of caffeine intake, regular coffee caffeine intake (mg/day) was significantly associated with reduced hepatic fibrosis of NAFLD (pooled MD −91.35; 95% CI −139.42 to −43.27; n = 2 studies). Conclusion: Although total caffeine intake is not associated with the prevalence or hepatic fibrosis of NAFLD, regular coffee caffeine consumption may significantly reduce hepatic fibrosis in patients with NAFLD.
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related
deaths worldwide. Underlying chronic liver disease has been associated with an
increased risk of developing HCC. This study is a review of the current
literature regarding the diagnosis, prognostic significance, and role of
treating underlying liver disease in patients who are at risk of primary liver
cancer. Relevant peer review of the English literature between 1980 and 2017
within PubMed and the Cochrane library was conducted for scientific content on
current advances in managing chronic liver diseases and the development of
hepatocellular carcinoma. Hepatitis C virus, hepatitis B virus (HBV),
nonalcoholic steatohepatitis, autoimmune hepatitis, hereditary hemochromatosis,
Wilson disease, primary biliary cirrhosis, α 1-antitrypsin deficiency, and
certain drugs lead to an increased risk of developing HCC. Patients with
underlying liver disease have an increased incidence of HCC. Hepatitis C virus,
HBV, and hemochromatosis can directly lead to HCC without the presence of
cirrhosis, while HCC related to other underlying liver diseases occurs in
patients with cirrhosis. Treating the underlying liver disease and reducing the
progression to cirrhosis should lead to a decreased incidence of HCC.
Background and study aims Carbon dioxide (CO2) insufflation has
been suggested to be an ideal alternative to room air insufflation to reduce
trapped air within the bowel lumen after balloon assisted enteroscopy (BAE). We
performed a systematic review and meta-analysis to assess the safety and
efficacy of utilizing CO2 insufflation as compared to room air during
BAE.
Patients and methods The primary outcome is mean change in visual analog
scale (VAS; 10 cm) at 1, 3, and 6 hours to assess pain. Secondary outcomes
include insertion depth (anterograde or retrograde), adverse events, total
enteroscopy rate, diagnostic yield, mean anesthetic dosage, and PaCO2
at procedure completion. We searched MEDLINE and the Cochrane Central Register
of Controlled Trials (CENTRAL) from inception until May 2015. Multiple
independent extractions were performed, the process was executed as per the
standards of the Cochrane collaboration.
Results Four randomized controlled trials (RCTs) were included in the
meta-analysis. VAS at 6 hours favored CO2 over room air (MD 0.13;
95 % CI 0.01, 0.25; p = 0.03). Anterograde insertion depth (cm) was improved in
the CO2 group (MD, 58.2; 95 % CI 17.17, 99.23; p = 0.005), with an
improvement in total enteroscopy rate in the CO2 group (RR 1.91; 95 %
CI 1.20, 3.06; p = 0.007). Mean dose of propofol (mg) favored CO2
compared to air (MD, – 70.53; 95 % CI – 115.07, – 25.98; P = 0.002).
There were no differences in adverse events in either group.
Conclusions Despite the ability of CO2 to improve insertion
depth and decrease amount of anesthesia required, further randomized control
trials are needed to determine the agent of choice for insufflation in balloon
assisted enteroscopy.
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