Drug-Induced Liver Injury in the Setting of Analgesic Use
No professional society has created guidelines to aid clinicians in the management of analgesics in the setting of hepatic injury. Acetaminophen overdose is the most common cause of acute liver failure in the United States. In the setting of acetaminophen toxicity, N-acetylcysteine remains the standard of care. Other analgesics including nonsteroidal antiinflammatory drugs, opiates, tricyclic antidepressants, and anticonvulsants rarely cause liver injury. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 1, 2019 Category: Gastroenterology Authors: Umar Darr, Norman Leslie Sussman Source Type: research

Quantitative Systems Toxicology Approaches to Understand and Predict Drug-Induced Liver Injury
The DILI-sim Initiative is a public-private partnership using quantitative systems toxicology to build a model (DILIsym) capable of understanding and predicting liver safety liabilities in drug candidates. The effort has provided insights into mechanisms underlying dose-dependent drug-induced liver injury (DILI) and interpatient differences in susceptibility to dose-dependent DILI. DILIsym may be useful in identifying drugs capable of causing idiosyncratic hepatotoxicity. DILIsym is used to optimize interpretation of traditional and newer serum biomarkers of DILI. DILIsym results are considered in drug development decision...
Source: Clinics in Liver Disease - October 31, 2019 Category: Gastroenterology Authors: Paul B. Watkins Source Type: research

Genetic Predisposition to Drug-Induced Liver Injury
Identification of genetic predisposition to drug-induced liver injury (DILI) is of paramount importance. Early candidate gene studies have identified various polymorphisms in drug-metabolizing genes that infer increased DILI susceptibility. Few of these have been confirmed in more recent genome-wide association studies, which have identified several specific human leukocyte antigen (HLA) alleles. The low incidence rate of DILI, however, leads to a low positive predictive value for currently identified genetic variations, making them unsuitable for pre-prescription screening. HLA screening incorporated into clinical practic...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Camilla Stephens, Ra úl J. Andrade Source Type: research

Drug Hepatotoxicity
Drug induced liver injury is a diagnosis that relies on the patterns of injury associated with specific medications and toxins. The process by which a clinician determines which agent is the likely culprit of the liver injury is called causality assessment. The Roussel Uclaf Causality Assessment Method (RUCAM) and additional causality assessment methods have been developed with the goal of providing a more standardized, less subjective approach to causality assessment. RUCAM remains the most used standardized method, however many physicians continue to rely on their experience for causality assessment. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Allyce Caines, Dilip Moonka Source Type: research

Liver Histology
When patients with suspected drug-induced liver injury (DILI) undergo liver biopsy, the pathologist can provide a wealth of information on the morphologic changes. The most common histologic patterns of DILI include mimics of acute and chronic hepatitis as well as acute cholestasis, chronic cholestasis, and a mixed pattern that combines hepatitis with cholestasis. The pattern may suggest etiologies of injury or correlate with reported patterns of injury for specific agents. Biopsy may exonerate or indict particular drugs as causal agents of injury and provide specific information on severity of injury and specific types of...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Billel Gasmi, David E. Kleiner Source Type: research

Acute Liver Failure Secondary to Drug-Induced Liver Injury
Drug-induced liver injury (DILI) is the most common cause of acute liver failure (ALF) in Western countries. Without liver transplantation, the mortality rate for ALF approaches greater than 80%. Acetaminophen-related ALF may be associated with a rapid progression but fortunately has a high chance for spontaneous survival compared with idiosyncratic DILI –related ALF. Several prognostic scoring systems for severe DILI have been developed to aid clinicians in selecting patients who require urgent liver transplantation. Patients who undergo liver transplantation for ALF are at risk for early graft loss and death and sh...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Maneerat Chayanupatkul, Thomas D. Schiano Source Type: research

Drug-Induced Liver Injury in the Setting of Chronic Liver Disease
Drug-induced liver injury (DILI) is an uncommon but significant cause of liver injury and need for liver transplant. DILI in the setting of chronic liver disease (CLD) is poorly understood. Clinical features of patients presenting with DILI in the setting of CLD are similar to those without CLD with the exception of a higher incidence of diabetes among those with CLD and DILI. Diagnosis of DILI in CLD is difficult because there are no objective biomarkers and current causality assessments have not been studied in this population. Differentiating DILI from exacerbation of underlying liver disease is even more challenging. (...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Nicholas A. Hoppmann, Meagan E. Gray, Brendan M. McGuire Source Type: research

Drug-induced Liver Injury Secondary to Herbal and Dietary Supplements
This article reviews the impact of liver injury cause by HDS and explores the hepatotoxic potential of such products and their individual ingredients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Elizabeth Zheng, Naemat Sandhu, Victor Navarro Source Type: research

Drug-Induced Liver Injury Resources and Reporting for the Clinician
Although many risk factors for developing drug-induced liver injury (DILI) have been identified and more than 1000 medications and herbal and dietary supplements are known to cause liver dysfunction, idiosyncratic drug reactions remain unpredictable and erratic. Varying effects of individual drugs on the event cascade and patient genetic polymorphisms lead to different clinical presentations. Mechanisms and causality scales have been developed to guide the clinician in diagnosis, and several databases and registries are available for reference and reporting. We identify and summarize the resources available to clinicians t...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Marisa Isaacson, Michael Babich Source Type: research

Epidemiology, Predisposing Factors, and Outcomes of Drug-Induced Liver Injury
Idiosyncratic drug-induced liver injury (DILI) is an underreported and underestimated adverse drug reaction. A recent population-based study found a crude incidence of approximately 19 cases per 100,000 a year. Amoxicillin-clavulanate continues to be the most commonly implicated agent in most Western countries, reported to occur in approximately 1 of 2300 users. In patients with drug-induced autoimmune hepatitis, liver tests often do not normalize with cessation of the drugs and require corticosteroids. DILI associated with jaundice can lead to death from liver failure or require liver transplantation in at least 10% of ca...
Source: Clinics in Liver Disease - October 28, 2019 Category: Gastroenterology Authors: Einar S. Bj örnsson Source Type: research

Frequent Offenders and Patterns of Injury
Given the liver ’s role in drug metabolism, it is uniquely sensitive to potential drug-induced liver injury (DILI) despite inherent protective mechanisms. In this article, we focus on the most common causes of DILI and their patterns of injury. Although not comprehensive, we attempt to cover several classes of co mmonly used drugs, and their associated patterns of injury and management. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 28, 2019 Category: Gastroenterology Authors: Jinyu Zhang, Deepak Venkat Source Type: research

Noncirrhotic Portal Hypertension
Idiopathic portal hypertension (IPH) and extrahepatic portal venous obstruction (EHPVO) are prototype noncirrhotic causes of portal hypertension (PHT), characterized by normal hepatic venous pressure gradient, variceal bleeds, and moderate to massive splenomegaly with preserved liver synthetic functions. Infections, toxins, and immunologic, prothrombotic and genetic disorders are possible causes in IPH, whereas prothrombotic and local factors around the portal vein lead to EHPVO. Growth failure, portal biliopathy, and minimal hepatic encephalopathy are long-term concerns in EHPVO. Surgical shunts and transjugular intrahepa...
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Authors: Rajeev Khanna, Shiv Kumar Sarin Source Type: research

Portal Hypertension
Portal hypertension (PH) is an increase in the pressure gradient between portal vein and inferior vena cava. Increased resistance occurs at different levels within the portal venous system, followed by increased portal venous inflow. PH is the main driver of cirrhosis decompensation. Varices on endoscopy or portosystemic collaterals on imaging indicate PH. Although its cause is determined mostly via noninvasive tests, the gold standard to measure portal pressure in cirrhosis and determine its severity is hepatic vein catheterization with determination of the hepatic venous pressure gradient. Measuring portal pressure is es...
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Authors: Laura Turco, Guadalupe Garcia-Tsao Source Type: research

Portal Hypertension
Portal hypertension is defined as increased blood pressure in the portal venous system, most often seen in the setting of advanced liver disease, such as cirrhosis. The development of portal hypertension is one of the major complications with advanced liver disease. Patients can be asymptomatic for years and considered compensated. However, the overt clinical manifestation of portal hypertension defines hepatic decompensation. The onset of hepatic decompensation represents a major turning point in patients with advanced liver disease, with a substantially negative impact on patients ’ life expectancy and quality. (So...
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Authors: Sammy Saab Tags: Preface Source Type: research

Portal Hypertension
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Authors: Sammy Saab Source Type: research

Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Source Type: research

Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Source Type: research

Contents
Sammy Saab (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Source Type: research

Forthcoming Issues
Drug Hepatotoxicity (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Source Type: research

Hepatic Encephalopathy Challenges, Burden, and Diagnostic and Therapeutic Approach
This article reviews the current literature to discuss the challenges and diagnostic and therapeutic approaches to HE. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - August 31, 2019 Category: Gastroenterology Authors: Beshoy Yanny, Adam Winters, Sandra Boutros, Sammy Saab Source Type: research

Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension
This article provides an updated evidence-based review of the indications for TIPS. Outcomes, complications, and adequate patient selection are also discussed. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - August 31, 2019 Category: Gastroenterology Authors: Matthew L. Hung, Edward Wolfgang Lee Source Type: research

An Update
Complications of portal hypertension include portal hypertensive gastropathy and colopathy. These disorders may cause chronic or acute gastrointestinal bleeding. The diagnosis is made endoscopically; therefore, there is great variability in their assessment. Portal hypertensive gastropathy can range from a mosaic-like pattern resembling snakeskin mucosa to frankly bleeding petechial lesions. Portal hypertensive colopathy has been less well-described and is variably characterized (erythema, vascular lesions, petechiae). Treatment is challenging and results are inconsistent. Currently, available evidence does not support the...
Source: Clinics in Liver Disease - August 30, 2019 Category: Gastroenterology Authors: Don C. Rockey Source Type: research

Varices
This article focuses on reviewing the current management strategies, including optimal medical, endoscopic, and angiographic interventions and their clinical outcomes to achieve these goals. Evidence based discussion is used with current references as much as possible. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - August 30, 2019 Category: Gastroenterology Authors: Thomas O.G. Kovacs, Dennis M. Jensen Source Type: research

Surgery in Patients with Portal Hypertension
Patients with portal hypertension will increasingly present for nontransplant surgery because of the increasing incidence of, and improving long-term survival for, chronic liver disease. Such patients have increased perioperative morbidity and mortality caused by the systemic pathophysiology of liver disease. Preoperative assessment should identify modifiable causes of liver injury and distinguish between compensated and decompensated cirrhosis. Risk stratification, which is crucial to preparing patients and their families for surgery, relies on scores such as Child-Turcotte-Pugh and Model for End-stage Liver Disease to tr...
Source: Clinics in Liver Disease - August 28, 2019 Category: Gastroenterology Authors: Melissa Wong, Ronald W. Busuttil Source Type: research

Frailty, Sarcopenia, and Malnutrition in Cirrhotic Patients
Sarcopenia, frailty, and malnutrition are prevalent complications in patients with end-stage liver disease (ESLD) and are associated with increased risk of morbidity and mortality. It is valuable to measure nutritional status, sarcopenia, and frailty over time in order to create interventions tailored to individuals with ESLD. Evaluating sarcopenia and frailty in patients with ESLD is challenging. Further work is needed to perfect these assessments so that clinicians can incorporate these assessments into their decision-making and management plans for cirrhotic patients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - August 21, 2019 Category: Gastroenterology Authors: Elizabeth S. Aby, Sammy Saab Source Type: research

Pulmonary Complications of Portal Hypertension
The most common pulmonary complications of chronic liver disease are hepatic hydrothorax, hepatopulmonary syndrome, and portopulmonary hypertension. Hepatic hydrothorax is a transudative pleural effusion in a patient with cirrhosis and no evidence of underlying cardiopulmonary disease. Hepatic hydrothorax develops owing to the movement of ascitic fluid into the pleural space. Hepatopulmonary syndrome and portopulmonary hypertension are pathologically linked by the presence of portal hypertension; however, their pathophysiologic mechanisms are significantly different. Hepatopulmonary syndrome is characterized by low pulmona...
Source: Clinics in Liver Disease - August 9, 2019 Category: Gastroenterology Authors: Rodrigo Cartin-Ceba, Michael J. Krowka Source Type: research

Ascites and Hepatorenal Syndrome
Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy, whereas that for refractory ascites (RA) is regular large-volume paracentesis with transjugular intrahepatic portosystemic shunt being offered in appropriate patients. Renal impairment occurs in up to 50% of patients with RA with type 1 hepatorenal syndrome (HRS) being most severe. Liver transplant remains the definitive treatment of eligible candidates with HRS, whereas combined liver and kidney transplant should be considered in patients requiring dialysis ...
Source: Clinics in Liver Disease - August 7, 2019 Category: Gastroenterology Authors: Danielle Adebayo, Shuet Fong Neong, Florence Wong Source Type: research

Pharmacologic Management of Portal Hypertension
Terlipressin, somatostatin, or octreotide are recommended as pharmacologic treatment of acute variceal hemorrhage. Nonselective β-blockers decrease the risk of variceal hemorrhage and hepatic decompensation, particularly in those 30% to 40% of patients with good hemodynamic response. Carvedilol, statins, and anticoagulants are promising agents in the management of portal hypertension. Recent advances in the pharmacologic tr eatment of portal hypertension have mainly focused on modifying an increased intrahepatic resistance through nitric oxide and/or modulation of vasoactive substances. Several novel pharmacologic age...
Source: Clinics in Liver Disease - August 7, 2019 Category: Gastroenterology Authors: Chalermrat Bunchorntavakul, K. Rajender Reddy Source Type: research

WHO Guidelines for Prevention, Care and Treatment of Individuals Infected with HBV
The prevalence of chronic hepatitis B (CHB) differs globally. CHB is responsible for 30% of all deaths from cirrhosis and 40% from hepatocellular carcinoma. The WHO developed guidelines in 2015 on prevention, care, and treatment of chronic HBV infection targeted to program managers in all health care settings, particularly in low- and middle-income countries. Several of the recommendations differ from those of the major Liver Societies, including the American Association for the Study of Liver Diseases (AASLD). This review highlights key differences between the AASLD and WHO guidelines and discusses the impact on managemen...
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Authors: Anusha Vittal, Marc G. Ghany Source Type: research

The Effects of Hepatic Steatosis on the Natural History of HBV Infection
Fatty liver prevalence is increasing and becoming a global health burden. Chronic hepatitis B infection (CHB) is one of the most common chronic viral infections. Steatosis in CHB patients increases risk of cirrhosis and hepatocellular carcinoma. Data from studies on the interaction between CHB and nonalcoholic fatty liver disease are not conclusive. Liver biopsy is the gold standard for diagnosis of fatty liver; however, noninvasive diagnostic tests have been developed to diagnose and predict fibrosis in CHB/NAFLD. Treatment guidelines are not clear. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Authors: Idrees Suliman, Noha Abdelgelil, Farah Kassamali, Tarek I. Hassanein Source Type: research

Hepatitis B Virus Update
Hepatitis B virus (HBV) continues to be a worldwide prevalent virus with global impact on the health of individuals and health economies of many countries, particularly in the Asia-Pacific regions and Africa. Entering an era of worldwide collaborations in health management, and a time of conceivable success to control or even eradicate liver viruses, we gathered a group of thought leaders and investigators to update the knowledge of HBV prevalence, management, and current status of new therapies. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Authors: Tarek I. Hassanein Tags: Preface Source Type: research

Hepatitis B Virus Update
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Authors: Tarek I. Hassanein Source Type: research

Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Source Type: research

Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Source Type: research

Contents
Tarek I. Hassanein (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Source Type: research

Forthcoming Issues
Portal Hypertension (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 30, 2019 Category: Gastroenterology Source Type: research

Screening and Prophylaxis to Prevent Hepatitis B Reactivation
This article covers the immunology of HBV reactivation, mechanisms of viral clearance, and recommendations for screening and prophylaxis. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 6, 2019 Category: Gastroenterology Authors: Joe Sasadeusz, Andrew Grigg, Peter D. Hughes, Seng Lee Lim, Michaela Lucas, Geoff McColl, Sue Anne McLachlan, Marion G. Peters, Nicholas Shackel, Monica Slavin, Vijaya Sundararajan, Alexander Thompson, Joseph Doyle, James Rickard, Peter De Cruz, Robert G. Source Type: research

Screening and Prophylaxis to Prevent Hepatitis B Reactivation
Organ transplantation is a lifesaving procedure for many patients. To prevent rejection or graft-versus-host disease, recipients require long-term immunosuppression. In patients who have ever been exposed to hepatitis B, it is possible for reactivation to occur; this includes patients who are anti –hepatitis B core antibody-positive only or both anti–hepatitis B core antibody-positive and hepatitis B surface antibody-positive. The susceptibility to this varies with the nature of the transplant. Hepatitis B can be transmitted from donor to recipient. It is important to assess the hepatitis B status and formulate...
Source: Clinics in Liver Disease - June 6, 2019 Category: Gastroenterology Authors: Joe Sasadeusz, Andrew Grigg, Peter D. Hughes, Seng Lee Lim, Michaela Lucas, Geoff McColl, Sue Anne McLachlan, Marion G. Peters, Nicholas Shackel, Monica Slavin, Vijaya Sundararajan, Alexander Thompson, Joseph Doyle, James Rickard, Peter De Cruz, Robert G. Source Type: research

Screening and Prophylaxis to Prevent Hepatitis B Reactivation
Patients with malignancies require chemotherapy and other immunosuppressive therapies for treatment. Because of this immunosuppression, in patients who have ever been exposed to hepatitis B it is possible for reactivation to occur. This reactivation can be fatal. Reactivation is particularly likely in patients who receive B cell –active agents such as rituximab. The occurrence of reactivation flares may also delay further chemotherapy, which can negatively affect the outcome of the underlying malignancy. Accordingly, it is important to screen patients for markers of hepatitis B and institute antiviral prophylaxis to ...
Source: Clinics in Liver Disease - June 6, 2019 Category: Gastroenterology Authors: Joe Sasadeusz, Andrew Grigg, Peter D. Hughes, Seng Lee Lim, Michaela Lucas, Geoff McColl, Sue Anne McLachlan, Marion G. Peters, Nicholas Shackel, Monica Slavin, Vijaya Sundararajan, Alexander Thompson, Joseph Doyle, James Rickard, Peter De Cruz, Robert G. Source Type: research

Screening and Prophylaxis to Prevent Hepatitis B Reactivation
Because of the relatively high prevalence of both hepatitis B infection and various forms of autoimmune inflammatory diseases treated with aggressive immunotherapy, reactivation of hepatitis B occurs in a substantial number of patients. The risk of reactivation depends on the degree and duration of immunosuppression. A large number of drug treatments have resulted in reactivation of hepatitis B virus infection and, based on the mechanisms and extent of immunosuppression, recommendations for some of the newer classes of immunosuppressive drugs are provided. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 5, 2019 Category: Gastroenterology Authors: Joe Sasadeusz, Andrew Grigg, Peter D. Hughes, Seng Lee Lim, Michaela Lucas, Geoff McColl, Sue Anne McLachlan, Marion G. Peters, Nicholas Shackel, Monica Slavin, Vijaya Sundararajan, Alexander Thompson, Joseph Doyle, James Rickard, Peter De Cruz, Robert G. Source Type: research

Hepatitis B in Pregnant Women and their Infants
Chronic hepatitis B is a global health problem affecting approximately 350 million to 400 million individuals worldwide, and mother to child transmission remains the major mode of transmission. Approximately 50% of chronically infected individuals acquire infection, either perinatally or early in childhood, predominantly in areas where hepatitis B virus (HBV) is endemic. Management of HBV in pregnancy presents a unique set of challenges. All infants born of hepatitis B surface antigen –positive mothers should receive postexposure immune prophylaxis with hepatitis B immunoglobulin and HBV vaccination within 24 ho...
Source: Clinics in Liver Disease - June 4, 2019 Category: Gastroenterology Authors: Alicia M. Cryer, Joanne C. Imperial Source Type: research

Understanding the Natural History of Hepatitis B Virus Infection and the New Definitions of Cure and the Endpoints of Clinical Trials
Hepatitis B virus (HBV) infection is the most common chronic viral infection worldwide and remains a significant global health problem. Chronic HBV infection can progress to cirrhosis, liver failure, and hepatocellular carcinoma. Outcome of chronic HBV infections depends on the host, virus, and environmental factors. Although effective prophylactic vaccines and antiviral therapies exist, curative treatment is not yet available. Intense research into a cure for HBV is ongoing and proposed definitions of cure and endpoints for clinical trials evaluating “curative” therapy are discussed. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 1, 2019 Category: Gastroenterology Authors: Alisa Likhitsup, Anna S. Lok Source Type: research

Drugs in the Pipeline for HBV
Chronic hepatitis B remains a significant cause of morbidity and mortality worldwide. Most hepatitis B virus (HBV)-infected individuals are neither diagnosed nor treated. In those treated, nucleos(t)ide polymerase inhibitors persistently suppress viremia to the limits of quantitation; however, few achieve a “functional cure,” defined as sustained off-treatment loss of detectable serum HBV DNA with or without loss of hepatitis B surface antigen. The low cure rate has been attributed to an inability to eliminate the viral reservoir of covalently closed circular DNA from hepatocytes. This review focus es on the di...
Source: Clinics in Liver Disease - May 29, 2019 Category: Gastroenterology Authors: Uri Lopatin Source Type: research

HBV/HCV Coinfection in the Era of HCV-DAAs
Epidemiologic studies suggest that 10% to 15% of patients infected with hepatitis C virus (HCV) are coinfected with hepatitis B virus (HBV) in the United States as a result of the shared modality of transmission, but the true prevalence is not known. The progression of liver disease to cirrhosis and hepatocellular carcinoma is generally faster in patients who are coinfected, and HCV is usually more predominant. Immunosuppression of the host or eradication of hepatitis C can change this paradigm, causing hepatitis B reactivation. This review describes HCV-HBV viral interactions, risks for reactivation, screening, and societ...
Source: Clinics in Liver Disease - May 27, 2019 Category: Gastroenterology Authors: Rashed Abdelaal, Beshoy Yanny, Mohamed El Kabany Source Type: research

HBV/HDV Coinfection
This article summarizes the available data on these emerging therapeutics. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 24, 2019 Category: Gastroenterology Authors: Christopher Koh, Ben L. Da, Jeffrey S. Glenn Source Type: research

Antiretroviral Effects on HBV/HIV Co-infection and the Natural History of Liver Disease
Hepatitis B virus (HBV) coinfection is common in persons with human immunodeficiency virus (HIV) infection, contributing significantly to morbidity and mortality. Many currently used HIV antiretroviral therapy (ART) regimens provide potent anti-HBV activity and it is recommended that HBV-HIV coinfected persons be treated with ART regimens containing tenofovir. ART has multiple benefits, including increasing rates of HBV clearance after initial infection and potent suppression of HBV DNA in chronic infection. Nevertheless, long-term studies have yet to demonstrate a profound positive impact of ART on HBV-related fibrosis pr...
Source: Clinics in Liver Disease - May 24, 2019 Category: Gastroenterology Authors: David L. Wyles Source Type: research

Hepatitis B Virus and Hepatitis D Virus Coinfection
This article summarizes the available data on these emerging therapeutics. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 24, 2019 Category: Gastroenterology Authors: Christopher Koh, Ben L. Da, Jeffrey S. Glenn Source Type: research

Global Perspective on Hepatitis B Virus Infections in the Era of Effective Vaccines
This article provides updated estimates of worldwide HBV disease prevalence and discusses how implementation of vaccination policies has affected HBV epidemiology. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 23, 2019 Category: Gastroenterology Authors: Chantal Gomes, Robert J. Wong, Robert G. Gish Source Type: research

Obstructive Sleep Apnea and the Liver
Nonalcoholic fatty liver disease (NAFLD), a disorder of altered metabolic pathways, is increasing worldwide. Recent studies established obstructive sleep apnea (OSA) and chronic intermittent hypoxia (CIH) as NAFLD risk factors. Studies have ascertained that CIH is independently related to NAFLD. Continuous positive airway pressure (CPAP) shows inconsistent results regarding its efficacy in improving NAFLD. Observational, longer duration CPAP therapy studies have shown positive outcomes, whereas shorter duration, randomized controlled trials have shown no benefit. A multifaceted approach to NAFLD management with sufficientl...
Source: Clinics in Liver Disease - April 2, 2019 Category: Gastroenterology Authors: Malav P. Parikh, Niyati M. Gupta, Arthur J. McCullough Source Type: research

Liver in Systemic Diseases
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 2, 2019 Category: Gastroenterology Authors: Jorge L. Herrera Source Type: research