Ruling in and ruling out with elastography in compensated advanced chronic liver disease

The recent letter by Jansen et al1 presenting an algorithm to rule out clinically significant portal hypertension (CSPH) by combining shear-wave elastography of liver (L-SWE) and spleen (S-SWE) is an important contribution to the increasing knowledge regarding non-invasive assessment of patients with compensated advanced chronic liver disease (cACLD). Baveno VI recommendations focused on transient elastography as a tool to rule in CSPH in patients with the authors cACLD of viral etiology,2 3 but there is no doubt that other related elastography techniques should work similarly. Also, recent UK guidelines on variceal bleeding introduced elastography for variceal screening and diagnosis.4 In their study, the authors concluded that combining L-SWE
Source: Gut - Category: Gastroenterology Authors: Tags: PostScript Source Type: research

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CONCLUSIONS: The evidence, obtained from one randomised clinical trial at high risk of bias, is very uncertain on whether sclerotherapy has an influence on mortality and if it may decrease first upper gastrointestinal or oesophageal variceal bleeding in children. The evidence is very uncertain on whether sclerotherapy has an influence on congestive hypertensive gastropathy, incidence on gastric varices, and incidence of bleeding from gastric varices. Health-related quality of life was not measured. There were no serious events caused by sclerotherapy, and analysis of non-serious adverse events could not be performed due to...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Variceal hemorrhage can be a life-threatening adverse event of chronic liver disease. In contrast to the well described guidelines for the management of portal hypertension (PH) in adults, there is limited evidence about the optimal prophylactic management of variceal bleeding in children. The study was carried out to assess the efficacy of endoscopic variceal ligation (EVL) as primary prophylaxis to prevent upper GI bleeding in children with PH.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Source Type: research
CONCLUSION: This novel TJP2 variant is associated with PFIC4 causing severe liver disease with cirrhosis and primary liver cancer in adolescents/adults. PMID: 32089630 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
This study aims to evaluate the accuracy of LSPS model assessed by ultrasound in well characterized patients with compensated advanced chronic liver disease. Methods Eligible patients with compensated advanced chronic liver disease were retrospectively enrolled between January 2017 and March 2018, who had undergone routine clinical and laboratory tests, liver stiffness measurement, ultrasound examination, and computed tomography scanning. Spleen sizes were evaluated by ultrasound and computed tomography reconstructed model, respectively. The correlation and agreement of spleen size and LSPS derived from ultrasound and c...
Source: European Journal of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
CONCLUSION: Pregnancy in PBC and PSC is well tolerated, but women should be counselled regarding the increased risk of preterm birth. Measurement of maternal ALT and bile acids may help identify women at risk of preterm delivery. PMID: 32012415 [PubMed - as supplied by publisher]
Source: BJOG : An International Journal of Obstetrics and Gynaecology - Category: OBGYN Authors: Tags: BJOG Source Type: research
CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of sclerotherapy versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis are lacking. Therefore, trials with adequate power and proper design, assessing the benefits and harms of sclerotherapy versus beta-blockers on patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events are needed. Unless such trials are conducted and the results become published, we cannot make any conclusions regarding the benefits or ...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSION: The CTP score but not HVPG or MELD were risk factors for severe PHG. Importantly, anemia and especially IDA are significantly more common in patients with severe PHG. PMID: 31912289 [PubMed - as supplied by publisher]
Source: Wiener Klinische Wochenschrift - Category: General Medicine Authors: Tags: Wien Klin Wochenschr Source Type: research
CONCLUSIONS: The 1-year follow-up results showed long-term effectiveness and safety of prasugrel at dosages approved in Japan for the treatment of IHD patients undergoing PCI. PMID: 31748446 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients ’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in th e management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and thera...
Source: Medicine - Category: Internal Medicine Authors: Tags: Management problems in liver disease Source Type: research
The severe form of CF liver disease, multilobular biliary cirrhosis (MBC) is associated with the almost invariable development of portal hypertension (PH) and the complications of variceal bleeding [1 –4] and unusually hepatic encephalopathy [5] or liver failure requiring transplantation [6]. These features in combination with splenomegaly and laboratory evidence of hypersplenism facilitate a diagnosis of MBC/PH which can be confirmed with non-invasive ultrasonography [2,7–9] and magnetic res onance imaging.
Source: Journal of Cystic Fibrosis - Category: Respiratory Medicine Authors: Source Type: research
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