Nir Hilzenrat's research while affiliated with University of British Columbia - Vancouver and other places

Publications (71)

Article
Background: Primary biliary cholangitis (PBC) is a rare, chronic autoimmune, cholestatic liver disease affecting approximately 318 per million Canadians. There is limited information regarding the characterization of this patient population in Canada. Consequently, we aim to describe a cohort of PBC patients managed across liver centres serving th...
Article
Palbociclib is a selective and reversible CDK4/6 inhibitor approved for patients presenting with HR+ HER2– locally advanced or metastatic breast cancer. Its adverse effect (AE) is mainly reported on the occurrence of leukopenia and fatigue. Even though palbociclib has an extensive hepatic metabolism, there are rare reports about significant liver t...
Article
Background Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Methods The aim of this study is to assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab betwee...
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Background Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes. Aims The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an ac...
Article
Background Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Aim To assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. Methods We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015–Jan...
Article
Rituximab is a monoclonal antibody to CD20, often used to treat B-cell lymphomas and various autoimmune diseases. While there is extensive literature on rituximab-induced liver injury related to hepatitis B reactivation, there have been no reports to date of autoimmune-type idiopathic drug-induced liver injury from this drug. We present a case of n...
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ABSTRACT Background: Sedation practices vary widely by region. In Canada, endoscopist-directed administration of a combination of fentanyl and midazolam is standard practice. A minority of cases are performed with propofol. Aims: To describe the safety of nonanaesthetist administered low-dose propofol as an adjunct to standard sedation. Methods: Th...
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Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn's disease. The patient is...
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Patients with cirrhosis are known to experience sleep disturbance, which negatively impacts health-related quality of life. OBJECTIVE: To assess the prevalence and predictors of sleep disturbance before and after liver transplantation (LT). METHODS: Both pre- and post-LT patients were administered the Basic Nordic Sleep Questionnaire. The primary o...
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Serum tumour necrosis factor-alpha (TNF-α) levels correlate negatively with hepatitis C virus (HCV) antiviral response. OBJECTIVES: To test the hypothesis that a single infliximab induction dose would positively influence on-treatment virological response and sustained virological response (SVR). METHODS: The present study was a phase IIIB, randomi...
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The liver enzymes, alanine transaminase (ALT) or aspartate transaminase (AST), are commonly used in clinical practice as screening as well as diagnostic tests for liver diseases. ALT is more specific for liver injury than AST and has been shown to be a good predictor of liver related and all-cause mortality. Asymptomatic mild hypertransaminasemia (...
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The portal hypertension is responsible for many of the manifestations of liver cirrhosis. Some of these complications are the direct consequences of portal hypertension, such as gastrointestinal bleeding from ruptured gastroesophageal varices and from portal hypertensive gastropathy and colopathy, ascites and hepatorenal syndrome, and hypersplenism...
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Chylous ascites is rare in clinical practice. It is characterized by milky-appearing peritoneal fluid with a triglycerides concentration of >1.25 mmol/l (110 mg/dl). Its pathophysiology is related to a disruption in the normal lymphatic flow. It is more common after trauma (including post surgery), neoplasia or atypical infections such as tuberculo...
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The authors describe two siblings, each with a different, rare genetic condition that affects liver function. The index case, the 18-year-old asymptomatic brother of a young man recently diagnosed with Wilson disease, presented for Wilson disease screening and was also found to have abnormal liver function suggestive of cholestasis. However, cerulo...
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High levels of profibrinogenic cytokine transforming factor beta (TGF-β), metalloprotease (MMP2), and tissue inhibitor of matrix metalloprotease 1 (TIMP1) contribute to fibrogenesis in hepatitis C virus (HCV) infection and in alcohol-induced liver disease (ALD). The aim of our study was to correlate noninvasive serum markers in ALD and HCV patients...
Article
The efficacy of individualised antiviral treatment durations for chronic hepatitis C remains unclear. To evaluate treatment durations based on virological responses at week 4, 8 and 12 of peginterferon alfa-2a plus ribavirin therapy. Previously untreated patients with HCV genotypes, other than 2 or 3, initiated therapy with peginterferon alfa-2a 18...
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Hepatitis C viral infection (HCV) results in liver damage leading to inflammation and fibrosis of the liver and increasing rates of hepatic decompensation and hepatocellular carcinoma (HCC). However, the host's immune response and viral determinants of liver disease progression are poorly understood. This review will address the determinants of liv...
Article
Gastrointestinal (GI) tract dysfunction is well documented following head injury. Our study sought to determine whether head injury causes an immediate impairment of the splanchnic circulation which may contribute to later GI sequelae. Three groups of eight rats each received either no closed head trauma (CHT) (group 1) or CHT (groups 2 and 3) imme...
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AND OBJECTIVES: To analyze whether rapid myelosuppression and a decrease in alanine aminotransferase (ALT) induced by standard interferon (IFN) and ribavirin (RBV) combination therapy predict a sustained viral response (SVR) in hepatitis C virus patients. PATIENTS AND METHODS: Data from 111 patients (mean age 48.1 years) with chronic hepatitis C vi...
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Nucleotide sequence analysis of the NS5B region was performed to identify genotypes of 8,479 hepatitis C virus (HCV) RNA-positive patient samples collected in the Canadian province of Quebec. Genotypes could be determined for 97.3% of patients. Genotypes 1 to 6 were found in 59.4, 9.0, 25.7, 3.6, 0.6, and 1.8% of patients, respectively. Two isolate...
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Liver transplantation (LT) offers a possible cure for patients with hepatocellular carcinoma (HCC) and cirrhosis. However, tumour progression while on the waiting list and tumour recurrence after LT are common. The prognostic significance of various pre- and postoperative variables were investigated in regard to tumour recurrence, with an emphasis...
Article
There is a discrepancy in outcome between the lactose tolerance and breath hydrogen tests for lactose maldigestion. The availability of a validated genetic test for lactase polymorphism allows a reevaluation of these tests. Thirty healthy adults participated in a 50-g lactose challenge test at a university clinic. Blood was drawn for genetic and ti...
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The results of antiviral therapy for hepatitis C virus (HCV) have improved recently with the use of pegylated interferon (PEG-IFN)/ribavirin (RBV) combination therapy. At this point, most patients with chronic HCV remain untreated. Thus, it is anticipated that therapy will be more appealing and prescribed more broadly than in the past, including in...
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Biopsy of the liver is an important diagnostic procedure. The procedure is invasive and may be painful for patients. Sedative drugs are not used because the associated drop in blood pressure mimics hemorrhage, a major complication of the procedure. Cognitive and behavioural techniques have been used to decrease stress in patients undergoing other m...
Article
Cryptic hepatitis C virus (HCV) infection relates to patients infected chronically with HCV that are seronegative but have HCV-RNA. These patients are not identified by the standard serological tests for HCV, which are based on detection of antibodies to core, NS3 and NS5 antigens. They will, therefore, be wrongly diagnosed as non-infected, and are...
Article
Distention of the colon is a major contributor to patient discomfort after colonoscopy. Some physicians and nurses believe insertion of a rectal tube relieves this discomfort and improves patient satisfaction with the procedure. This prospective, randomized, controlled trial assessed rectal tube insertion for reduction or prevention of abdominal bl...
Article
In portal hypertensive rats, hemorrhage and acute volume restitution with Haemaccel induced increased cardiac output and portal venous inflow. In the present study, the late hemodynamic effects of this procedure were explored. Portal hypertension was induced by portal vein constriction. Blood was withdrawn 11.2 +/- 3.2 days later, at a rate of 0.3...
Article
Recently, we found in a portal hypertensive rat model that hemorrhage and volume restitution with Haemaccel, a low viscosity plasma expander, induced an increase in cardiac output and portal venous inflow. The present study was conducted to evaluate whether pretreatment with propranolol will attenuate these hyperdynamic changes. Portal hypertension...
Article
Background and Aims: Recently, we found in a portal hypertensive rat model that hemorrhage and volume restitution with Haemaccel, a low viscosity plasma expander, induced an increase in cardiac output and portal venous inflow. The present study was conducted to evaluate whether pretreatment with propranolol will attenuate these hyperdynamic changes...
Article
Insulin, in addition to its metabolic function, was found to induce skeletal muscle vasodilatation after acute administration. The vasoactive effects of sustained euglycemic hyperinsulinemia, especially in the splanchnic circulation, are less well known. The aim of this study was to evaluate the systemic and splanchnic hemodynamic effects of sustai...
Article
Hemorrhage and volume restitution with commercially available solutions is followed by reduced blood viscosity. Consequent hemodynamic changes may arise not only from the reduced viscosity itself but also from changes in vascular geometry induced by autoregulation processes. Vascular hindrance reflects the contribution of vascular geometry to flow....
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Hepatitis C virus (HCV) infection is found in 80% to 90% of patients with essential mixed cryoglobulinemia (EMC) type II, which is associated with monoclonal IgMk produced by monoclonal B cells. It was investigated whether bcl-2 rearrangement is associated with the clonal B-cell proliferation of EMC induced by hepatitis C. The study groups were com...
Article
Hepatitis C virus (HCV) infection is found in 80% to 90% of patients with essential mixed cryoglobulinemia (EMC) type II, which is associated with monoclonal IgMk produced by monoclonal B cells. It was investigated whether bcl-2 rearrangement is associated with the clonal B-cell proliferation of EMC induced by hepatitis C. The study groups were com...
Article
A 57-year-old man with long-term untreated Crohn's disease presented with exacerbation of his bowel disease, volume depletion, nephrotic syndrome and rapid decline in renal function. Renal biopsy revealed amyloidosis and extensive interstitial infiltration. Initiation of steroid therapy was associated with improvement in renal function and postpone...
Article
Acquired infection with hepatitis C virus (HCV) in hemodialysis patients has been described lately. In dialysis units in Italy and France, the prevalence and incidence of HCV are 20-60% and 1-2%, respectively. Most infected patients develop chronic hepatitis. The clinical presentation of acute HCV in hemodialysis patients is very mild and therefore...
Article
The aim of this study was to examine, in a portal hypertensive rat model, the hemodynamic changes following hemorrhage and volume restitution with blood and Haemaccel (a low viscosity, volume expander). Portal hypertension was induced by portal vein constriction. Under ketamine anesthesia, blood was withdrawn at a constant rate of 0.3 ml/min, for 1...
Article
The pathogenic mechanisms for autoimmune hepatitis (AIH) are not completely known. Susceptibility to AIH is associated with the human leukocyte antigens (HLA) class II: DR3 and DR4. Nevertheless, AIH does not have a strong genetic predisposition, suggesting that other factors are involved. Perhaps the strongest evidence of a viral cause for AIH exi...
Article
Spontaneous internal jugular thrombosis is a rare vascular disorder. It usually occurs as a result of external pressure due to a tumor, infection or as a result of damage to the vessel wall after trauma or central venous catheterization. We report a 35-year-old woman who suffered from severe pulmonary hypertension due to chronic cystic lung disease...
Article
Colonic angiodysplasia is one of the most frequent causes of recurrent lower gastrointestinal tract bleeding, mainly in the elderly. In 50% of patients multiple angiodysplastic lesions were reported when they were the cause of rectal bleeding. Bleeding from angiodysplasia is more severe and less responsive to treatment in those with coagulation dis...
Article
Recent interest has been expressed in rheumatic manifestations in hepatitis C virus (HCV)-infected populations. The aim of this study was to determine the prevalence and characteristics of the musculoskeletal manifestations and serological markers of autoimmunity in HCV-infected patients in Israel. Ninety anti-HCV-positive patients were consecutive...
Article
Rapid urease tests are used for quick identification of Helicobacter pylori during upper gastrointestinal endoscopy. Rapid urease test solutions contain urea, which in the presence of H. pylori urease, generates ammonia, which changes the test medium color to indicate a positive result. Theoretically, Xylocaine spray (ASTRA, Södertalje, Sweden), wh...
Article
Chronic hepatitis C virus (HCV) infection may lead to many extrahepatic manifestations which pose a serious therapeutic challenge. Recently, increasing evidence suggesting an association between iron overload and chronic HCV infection has emerged. However, the effect of iron reduction therapy on extrahepatic manifestations of HCV infection is unkno...
Article
Fibromyalgia syndrome (FS) is a common disorder of diffuse pain in the muscles or joints accompanied by tenderness at specific tender points and a constellation of related symptoms. The potential role of infections in the pathogenesis of FS has only recently been investigated. To evaluate the prevalence of FS and to assess tenderness thresholds in...
Article
Most requests for gastroenterology consultations for hospitalized patients are for endoscopic procedures. Open access endoscopy has been evaluated in several institutions for outpatients. Our aim was to evaluate an open access policy for hospitalized patients. Since April of 1996, patients hospitalized in the Soroka Medical Center have been referre...
Article
An association between chronic hepatitis C (HCV) infection and non-Hodgkin's lymphoma has been reported. We carried out this study to evaluate the possibility of an association between HCV infection and other extrahepatic malignancies. The medical records of 103 unselected, consecutively chosen, anti HCV-positive and 105 hepatitis B surface antigen...
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A 24-year-old male with Crohn's disease who developed three independent episodes of cholestatic liver disease over an eight-year period is described. The first episode was related to an idiosyncratic drug reaction while on sulfasalazine. The second episode, at the time of an exacerbation of his colitis, was characterized by moderate portal inflamma...
Article
The hemodynamic changes occurring early in the course of non-insulin-dependent diabetes mellitus (Type II, NIDDM) are not well understood. We applied the radioactive microspheres technique at an early stage of diabetes in Psammomys abesus (sand rat), an established animal model of spontaneous NIDDM. Ten diabetic and 7 control male animals were stud...
Article
Portal hypertension is accompanied by a hyperdynamic circulatory state that shares some similarities with thyrotoxicosis. This study was conducted in order to investigate the hemodynamic effects of hypothyroidism in a rat model with portal hypertension induced by partial portal vein ligation (PVL). Four groups of 10 rats each were studied: normal c...
Article
A 57-year-old black man presented with a 2-week history of abdominal pain, weight loss, anorexia, and constipation. His history was significant for remote Hodgkin's disease and systemic sarcoidosis. Physical examination showed abdominal distention and hyperactive bowel sounds, periorbital swelling, and mandibular lymphadenopathy. A barium enema exa...
Article
The risk of developing an acute coronary event (ACE) in patients presenting to the emergency room with chest pain or shortness of breath was assessed in a prospective blinded fashion. The Time Insensitive Predictive Instrument (TIPI), which is appropriate for both prospective and retrospective assessment, was used to determine the risk. The average...
Article
Although polycythemia vera is one of the reported causes for cerebral infarction, isolated cerebellar infarction, a rare disorder, was never reported in combination with polycythemia vera. This is a report of a 72-year-old woman in whom isolated cerebellar infarction was the presenting manifestation of polycythemia vera. The patient was treated wit...

Citations

... This case presents important clinical issues that HCC can occur in patients with CD, even without underlying liver diseases for HCC. The occurrence of HCC among patients with CD is extremely rare, with only 15 cases, including our case, published as case reports in the literature [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Table 1 summarizes the clinicopathological features of HCC in CD patients. ...
... It has been recognized in recent years that the likelihood of achieving a SVR during treatment with PEG-IFN/RBV was directly related to when the patient became HCV RNA undetectable during therapy (10). Patients with a RVR, who became HCV RNA undetectable within 4 weeks after initiating treatment, had SVR rates in the 85-90% range and several studies strongly suggested that these patients could receive only 24 weeks of PEG-IFN/ RBV (11)(12)(13)(14). This observation forms the cornerstone of response guided therapy (RGT) (10,15,16); a concept that was readily incorporated into the treatment schemes developed for boceprevir and telaprevir. ...
... On the other hand, patients with liver disease and cirrhosis show perturbed sleep and daily rhythm of body temperature (105,106). Decreased testosterone and GH levels as well as sleep problems caused by NAFLD are improved after liver transplantation, suggesting that the liver could play a role in these endocrine and circadian perturbations (107)(108)(109). However, inactivating Bmal1 only in hepatocytes has no impact on the circadian rhythm of the animals (11) and is not sufficient to drive the endocrine perturbations observed in animals with a global deletion of Bmal1 (Fig. 6E). ...
... Psoriasis has been reported to be associated with a high concentration of TNF-α (41) and infliximab treatment can neutralize the biological activity of TNF-α (42). However, the role of the TNF-α in the pathogenesis of psoriasis remains unclear. ...
... Excess adiposity and liver steatosis can also be underlying causes of deranged laboratory findings. Furthermore, liver steatosis and mild hypertransaminasemia are very common in the population, thereby not specific to TS [58,59]. ...
... Among these other sequences, six 6l (VN507, VN530, VN531, VN606, VN655 and VT681), two 6o (VN4 and VT316) and two 6p (D3 and VN12) sequences had origins in Vietnam (Noppornpanth et al., 2006b;Stuyver et al., 1995;Tokita et al., 1994). Two 6o (QC30 and QC33), two 6p (QC123 and QC190) and four 6q (QC57, QC164, QC176 and QC189) sequences were isolated in Vietnamese or Cambodian immigrants in Quebec, Canada (Bernier et al., 1996;Murphy et al., 2003). Another 6q sequence (IG93336) was recorded from Laos, but detailed information on this isolate has not been published. ...
... Even if, to date, the exact correlation between HCV and arthritis is not wellestablished, various reports have established that the eradication of HCV with the DAAs helped solving articular manifestations [31,32]; these correlations might be explained by examining the molecular mechanisms between HCV and B-lymphocytes. First of all, HCV-envelope E2 protein is a viral protein which is able to bind to CD81 (widely expressed on cell membrane of both hepatocytes and B-cells); this complex can create a bridge with CD21 on the surface of the B-lymphocyte thus reducing the threshold for its activation. ...
... Changes in microbiome are seen in both DAFLD and MAFLD [57]. The gut microbiome is a contributing factor in MAFLD and ALD [58][59][60]. An increase in the absorption of gut endotoxins and their translocation via the portal vein to the liver is well recognized in ALD. ...
... The variceal wall thickness can be evaluated visually by the presence of red wale markings, which are signs of particularly thin variceal wall. 3 Therefore, when it comes to the assessment of the risk of bleeding with esophagogastroduodenoscopy (EGD), size and the presence of red signs are particularly important. ...