简介：Nonalcoholicfattyliverdisease(NAFLD),definedasabnormalaccumulation(>5%)ofhepatictriglyceridewithoutexcessalcoholintake,isthemostcommonformofchronicliverdiseaseinadultsandchildrenintheUnitedStates.NAFLDencompassesaspectrumofhistologicfindingsincludinguncomplicatedsteatosis,steatosiswithinflammationandsteatohepatitis[nonalcoholicsteatohepatitis(NASH)];thelattercanadvancetocirrhosisandhepatocellularcarcinoma.NASHiscurrentlyacceptedasthehepaticmanifestationofthesetofcardiovascularriskfactorscollectivelyknownasmetabolicsyndrome.In1999asystemforhistologicgradingandstagingforNASHwasproposed;thiswasrevisedbytheNASHClinicalResearchNetworkin2005fortheentirespectrumoflesionsinNAFLD,includingthelesionsandpatternsofpediatricNAFLD,andforapplicationinclinicalresearchtrials.Diagnosisremainsdistinctfromgradeandstage.ArecentEuropeanproposalseparatessteatosisfromactivitytoderiveanumericdiagnosisofNASH.Eventhoughtherehavebeenpromisingadvancementsinnon-invasivetesting,thesetestsarenotyetdetailedenoughtoreplacethefullrangeoffindingsprovidedbyliverbiopsyevaluation.Limitationsofbiopsyareacknowledged,butliverbiopsyremainsthe'goldstandard'fordiagnosisanddeterminationofamountsofnecroinflammatoryactivity,andlocationoffibrosis,aswellasremodelingoftheparenchymainNASH.ThisreviewfocusesonthespecifichistologiclesionsofNAFLDandNASH,gradingandstaging,differentialdiagnosestobeconsidered,andthecontinuingroleoftheliverbiopsyinthisimportantliverdisease.

简介：AIM:Toanalyzethepotentialrelationshipbetweengastroesophagealrefluxdisease(GERD)andthedevelopmentofatrialfibrillation(AF).METHODS:Usingthekeywords'atrialfibrillationandgastroesophagealreflux','atrialfibrillationandesophagitis,peptic','atrialfibrillationandhernia,hiatal'thePubMed,EMBASE,CochraneLibrary,OVIDSP,WILEYdatabaseswerescreenedforrelevantpublicationsonGERDandAFinadultsbetweenJanuary1972-December2013.StudieswritteninlanguagesotherthanEnglishorFrench,studiesnotperformedinhumans,reviews,casereports,abstracts,conferencepresentations,letterstotheeditor,editorials,commentsandopinionswerenottakenintoconsideration.ArticlestreatingthesubjectofradiofrequencyablationofAFandtheconsecutivedevelopmentofGERDwerealsoexcluded.RESULTS:Twothousandonehundredsixty-onetitleswerefoundofwhich8articlesmettheinclusioncriteria.ThepresenceofAFinpatientswithGERDwasreportedtobebetween0.62%-14%,highercomparedtothosewithoutGERD.EpidemiologicaldataprovidedbytheseobservationalstudiesshowedthatpatientswithGERD,especiallythosewithmoresevereGERD-relatedsymptoms,hadanincreasedriskofdevelopingAFcomparedwiththosewithoutGERD,butacausalrelationshipbetweenGERDandAFcouldnotbeestablishedbasedonthesestudies.ThemechanismsofAFasaconsequenceofGERDremainlargelyunknown,withinflammationandvagalstimulationplayingapossibleroleinthedevelopmentofthesedisorders.TreatmentwithprotonpompinhibitorsmayimprovesymptomsrelatedtoAFandfacilitateconversiontosinusrhythm.CONCLUSION:AlthoughlinksbetweenAFandGERDexist,largerandomizedclinicalstudiesarerequiredforabetterunderstandingoftherelationshipbetweenthesetwoentities.