Non-selective Beta-Blockers in Decompensated Cirrhosis
AbstractPurpose of ReviewThe safety of non-selective beta-blockers (NSBB) in decompensated cirrhosis, particularly in patients with refractory ascites, has recently been called int question. This review summarizes recent evidence on the role of NSBBs in decompensated cirrhosis and provides recommendations for their appropriate use.Recent FindingsCurrent evidence on the use of NSBBs in decompensated cirrhosis is mixed and is based on observational data. An initial study in 2010 demonstrated decreased survival in patients with refractory ascites who received propranolol compared to those who did not. Since then, multiple sub...
Source: Current Hepatitis Reports - July 1, 2020 Category: Infectious Diseases Source Type: research

Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease
AbstractPurpose of ReviewAlbumin administration is recommended to prevent or treat specific complications of decompensated cirrhosis based on its capacity to expand plasma volume. However, the molecule also has many other biological properties that are unrelated to the oncotic activity. The purpose of this review is to examine the hemodynamic and systemic effects of albumin administration in patients with decompensated cirrhosis.Recent FindingsBesides plasma expansion, albumin appears to act against inflammation, facilitate immunocompetence, and improve cardiac and endothelial function, thus antagonizing critical steps in ...
Source: Current Hepatitis Reports - July 1, 2020 Category: Infectious Diseases Source Type: research

Esophageal Varices: Primary Prophylaxis and Prevention and Management of Rebleeding
AbstractPurpose of ReviewPortal hypertension is an important manifestation of chronic liver diseases, and the complications of portal hypertension, especially gastroesophageal variceal hemorrhage, are associated with high morbidity and mortality.Recent FindingsImportant advances made in the past several decades in risk stratification and management of patients with portal hypertension and varices have significantly improved patient outcomes.SummaryThis review addresses the pathophysiology, natural history, differential diagnoses, and diagnostic criteria of portal hypertension. We will also discuss the primary prevention, a...
Source: Current Hepatitis Reports - June 30, 2020 Category: Infectious Diseases Source Type: research

Cardiovascular Disease in Nonalcoholic Steatohepatitis: Screening and Management
AbstractPurpose of ReviewThe global burden of nonalcoholic steatohepatitis (NASH) as a major cause of chronic liver disease continues to rise. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in this patient population. The current review summarizes recent advances in the understanding of CVD in NASH and strategies for screening and management.Recent FindingsLarge genetic epidemiological studies support the intricate role of the metabolic syndrome in the pathophysiology of CVD risk in patients with NASH. Atherosclerotic CVD risk scores can predict elevated CV risk in NASH, but additional work is n...
Source: Current Hepatitis Reports - June 29, 2020 Category: Infectious Diseases Source Type: research

Budd-Chiari Syndrome: Anticoagulation, TIPS, or Transplant
ConclusionsEarly diagnosis and treatment have improved the outcome of patients with BCS. However, BCS management remains a challenge, requiring multidisciplinary teams in referral centers with BCS expertise. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - June 27, 2020 Category: Infectious Diseases Source Type: research

Portal Hypertensive Ascites: Current Status
AbstractPurpose of ReviewAscites is defined as the pathological accumulation of excess free fluid within the peritoneal cavity. This review article summarizes the pathogenesis and management of ascites due to cirrhosis and portal hypertension.Recent FindingsThe development of ascites signifies the transition from a compensated to a decompensated phase of cirrhosis. Management of ascites in patients who fail conventional therapy is a topic of ongoing research, as the only definitive treatment in such cases is liver transplantation.SummaryThe latest recommendations on sodium restriction, the use and discontinuation of diuret...
Source: Current Hepatitis Reports - June 24, 2020 Category: Infectious Diseases Source Type: research

Lessons Learned from Faecal Microbiota Transplantation in Cirrhosis
AbstractPurpose of ReviewWe examine recent developments in the treatment of cirrhosis by gut microbiome manipulation specifically focusing on the phase 1 safety and feasibility trials of faecal microbiota transplantation (FMT). We interrogate the published data so far on its feasibility, safety and efficacy.Recent FindingsA large number of trials have demonstrated the efficacy of FMT in treating recurrentClostridium difficile infection which is now considered standard of care. In cirrhosis, FMT is still being evaluated and there are a number of clinical trials underway. There are two phase 1 pilot safety studies that have ...
Source: Current Hepatitis Reports - June 24, 2020 Category: Infectious Diseases Source Type: research

Point of Care Diagnostic Testing for Hepatitis B Virus
AbstractPurpose of ReviewAs we strive to reach the World Health Organization (WHO) goal of eliminating viral hepatitis as a public health threat by 2030, point of care tests (POCTs) will be important in low- to middle-income and developed countries. This review aims to investigate available POCT choices for hepatitis B virus (HBV) and to provide an algorithm for screening, assessing, and monitoring chronic HBV.Recent FindingsThere are 3 WHO pre-qualified rapid diagnostic assays for hepatitis B surface antigen (HBsAg) that are sensitive, specific, and reliable in screening for HBV: SD Bioline, Determine 2, and VIKIA. POCTs ...
Source: Current Hepatitis Reports - June 22, 2020 Category: Infectious Diseases Source Type: research

Role of Core/Capsid Inhibitors in Functional Cure Strategies for Chronic Hepatitis B
This article reviews the preclinical and clinical results of CpAMs.Recent FindingsCpAMs interfere with the hepatitis B virus (HBV) nucleocapsid assembly and also exert a secondary action on covalently closed circular DNA replenishment. CpAMs are able to sustainably suppress hepatitis B viral load and viral antigens in in vivo studies. In phase I/II clinical trials, CpAMs are well tolerated and are efficacious in suppressing viral replication. CpAMs also have synergistic antiviral effects when combined with nucleoside analogues or pegylated interferon. The clinical data has yet to demonstrate the capability of CpAMs in indu...
Source: Current Hepatitis Reports - June 22, 2020 Category: Infectious Diseases Source Type: research

Assessment of HCC Risk in Patients with Chronic HBV (REACH, PAGE-B, and Beyond)
AbstractPurpose of ReviewTo provide an updated overview on the current status of risk prediction scores for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus infection.Recent FindingsMore HCC risk scores have been developed, validated, and optimized (e.g., with liver stiffness measurement) in different patient and ethnic groups. Risk scores for treated patients with high negative predictive values would be able to identify patients who may not need HCC surveillance anymore as their HCC risk has been reduced by antiviral therapy.SummaryCurrent HCC risk scores can accurately predict HCC in specific po...
Source: Current Hepatitis Reports - June 19, 2020 Category: Infectious Diseases Source Type: research

Selection for Liver Transplantation: Indications and Evaluation
AbstractPurpose of ReviewLiver transplantation is an important therapeutic option for patients with life-limiting liver disease, which may present in the form of acute liver failure, end-stage chronic liver disease, primary hepatic cancers, or inborn metabolic disorders. While significant strides have been made with respect to liver transplantation outcomes, the practice is constrained by an organ supply/demand mismatch. The purpose of this review, therefore, is to review the general indications and contraindication to liver transplantation, and to provide an overview of the transplant evaluation process. These considerati...
Source: Current Hepatitis Reports - June 19, 2020 Category: Infectious Diseases Source Type: research

Early Transplantation in Acute on Chronic Liver Failure: Who and When
AbstractPurpose of ReviewAcute on chronic liver failure (ACLF) is a unique syndrome that afflicts patients with chronic liver disease and results in high short-term mortality,>  50% at 28 days in patients with severe ACLF (grade 3, ACLF-3). Given this prognosis, there is an urgent need to understand risk factors for this condition, as well as selection criteria for patients who may benefit from liver transplantation (LT).Recent FindingsSeveral studies have identified risk factors for developing ACLF, including higher model for end-stage liver disease score, anemia, and morbid obesity, as well ACLF mortality,...
Source: Current Hepatitis Reports - June 18, 2020 Category: Infectious Diseases Source Type: research

PSC and Overlap Syndromes
AbstractPurpose of ReviewOverlap syndromes show concomitant or sequential findings of two or more autoimmune liver diseases. Primary sclerosing cholangitis (PSC) is rare and PSC-overlap syndromes are much rarer. There is limited data in PSC-overlap syndromes which pose significant diagnostic and therapeutic challenges for this condition. We summarized the published data in this review to update the management strategies in PSC-overlap syndrome.Recent FindingsPSC incidence is 0.77 –1 per 100,000 person/years, of which 2–10% are reported to have PSC-autoimmune hepatitis (AIH) overlap syndrome. The incidence of PS...
Source: Current Hepatitis Reports - May 19, 2020 Category: Infectious Diseases Source Type: research

Therapeutic and Prophylactic Anticoagulation in Cirrhosis Patients
We present current data in cirrhosis patients regarding the treatment of portal vein and peripheral deep vein thrombosis and prophylactic strategies for peripheral thrombotic disease as well as for cirrhosis patients with co-existent atrial fibrillation. We also present very provocative data on prophylaxis of portal vein thrombosis in patients with underlying liver disease. The latter, if confirmed with blinded prospective study, could have an impact on chronic liver failure and the need for liver transplantation. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - April 24, 2020 Category: Infectious Diseases Source Type: research

Do Nutritional Interventions Improve the Outcomes of Patients with Cirrhosis and Ascites: a Systematic Review of Randomized Trials
AbstractPurpose of ReviewAscites is a common, morbid complication of cirrhosis. Nutritional interventions such as sodium restriction and high-protein diet are considered standard of care. However, their evidence base is limited. We performed a systematic review of randomized trials of nutritional interventions for ascites.Recent FindingsIncreasing consumption of calories and protein alone was ineffective. Studies reached contradictory conclusions regarding sodium restriction in patients taking combination diuretics. Intravenous amino acid infusion alone did not improve outcomes, and peripheral parenteral nutrition did not ...
Source: Current Hepatitis Reports - April 22, 2020 Category: Infectious Diseases Source Type: research

Mechanisms of Fibrosis in Primary Biliary Cholangitis
AbstractBackgroundPrimary biliary cholangitis (PBC) is an autoimmune liver disease featured with bile duct injury, ductopenia and proliferation, periportal inflammation and fibrosis. Clinical manifestations of PBC vary from almost no symptoms to different degrees of pruritus plus symptoms of liver dysfunction.Purpose of ReviewThis review intends to update our understanding in the mechanisms of hepatic fibrogenesis under chronic biliary injury.Recent FindingsUnderlying mechanisms are proposed for a better understanding and more effective therapeutic targets. With genetic predisposition, lesions from bile ducts cause damage ...
Source: Current Hepatitis Reports - April 21, 2020 Category: Infectious Diseases Source Type: research

The Role of Cholangioscopy in the Management of Primary Sclerosing Cholangitis
AbstractPurpose of ReviewPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the biliary ducts associated with a high risk for hepatobiliary malignancies. Up to 50% of PSC patients develop dominant strictures (DS) and warrant investigations to exclude cholangiocarcinoma (CCA). Most patients undergo endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology, but diagnostic accuracy is suboptimal, with sensitivity varying between 8 and 43% for the detection of CCA. Negative brush cytology often results in repeat ERCPs and need for heightened...
Source: Current Hepatitis Reports - April 21, 2020 Category: Infectious Diseases Source Type: research

Sarcopenia in Liver Transplantation: an Update
AbstractPurpose of ReviewPatients undergoing liver transplantation (LT) are at high risk of sarcopenia and associated physical frailty. This review summarises advances in our knowledge of the definition, assessment, clinical implications and management of sarcopenia in LT.Recent FindingsSarcopenia is associated with increased mortality, morbidity, physical disability and poor quality of life both before and after LT. Assessment tools have evolved from solely relying on imaging (i.e. muscle area only) to reproducible measures of function and physical performance status (i.e. liver frailty index). The multi-faceted managemen...
Source: Current Hepatitis Reports - April 18, 2020 Category: Infectious Diseases Source Type: research

Newer Approaches to the Management of Pruritus in Cholestatic Liver Disease
AbstractPurpose of ReviewChronic pruritus represents a burdensome symptom in cholestatic liver disease. This review recommends a stepwise therapeutic approach, alongside with providing information on epidemiology, pathophysiology, and novel drug targets.Recent FindingsCurrent epidemiological data emphasize chronic itch as a major symptom in immune-mediated liver diseases such as primary biliary cholangitis affecting up to 70% of patients with a significant number suffering from long-lasting and severe pruritus. κ-opioid receptor (KOR) agonists, PPAR agonists, and ileal bile acid transporter (IBAT) inhibitors are curr...
Source: Current Hepatitis Reports - April 16, 2020 Category: Infectious Diseases Source Type: research

What Diet Should I Recommend My Patient with Hepatic Encephalopathy?
AbstractPurpose of ReviewThe burden of malnutrition is high in patients with cirrhosis, especially in those with hepatic encephalopathy (HE). This has a bearing on increased morbidity and mortality. Heightened attention needs to be paid to screen the patients at high nutritional risk both in the outpatient and hospitalized settings. This review summarizes the current evidence for nutritional support in HE patients and compares the recommendations about nutritional requirement as laid out by various organizations.Recent FindingsOn survey of the literature, there is a consensus on avoiding protein restriction of the diets in...
Source: Current Hepatitis Reports - March 5, 2020 Category: Infectious Diseases Source Type: research

Food as Therapy for Frailty
AbstractPurpose of ReviewFrailty in end-stage liver disease is a risk factor for mortality and other serious complications for transplant-waitlist patients. Multiple interventions have been studied to try to mitigate these effects by targeting contributors to frailty, most notably sarcopenia and hepatic encephalopathy. This review provides an evidence-based summary of interventions that have been recommended to prevent or reverse frailty and its contributors.Recent FindingsCurrent nutritional recommendations for frailty in end-stage liver disease focus on mitigating the effects of ammonia toxicity, increased energy expendi...
Source: Current Hepatitis Reports - March 3, 2020 Category: Infectious Diseases Source Type: research

Nutrition Management in the Critically Ill Patient with Cirrhosis
AbstractPurpose of ReviewNutrition assessment of patients with liver failure in the intensive care unit is complex due to the decompensated state of the patient. Malnutrition is highly prevalent and recommendations for protein intake and other supportive measures have changed over the past several years. This review will describe the nutritional assessment of patients with cirrhosis in the intensive care unit and provide recommendations for updated best practices of nutritional support.Recent FindingsMore recent research has focused on the benefit of early nutrition interventions, avoiding prolonged fasting, and higher pro...
Source: Current Hepatitis Reports - February 29, 2020 Category: Infectious Diseases Source Type: research

Nutrition in Cholestatic Liver Disease
AbstractPurpose of ReviewCholestatic liver disease, including primary biliary cholangitis and primary sclerosing cholangitis, can be associated with numerous extrahepatic complications. Of these, malnutrition can negatively impact quality of life in these patients. Achieving nutritional optimization in patients with cholestatic liver disease is an essential component in the overall management of the disease.Recent FindingsThrough various mechanisms, including abnormalities in bile acid metabolism, malabsorption, anorexia, and increased metabolic rate, chronic malnutrition in cholestatic liver disease can lead to vitamin, m...
Source: Current Hepatitis Reports - February 25, 2020 Category: Infectious Diseases Source Type: research

Recurrent Disease After Liver Transplantation
AbstractPurpose of ReviewLiver transplantation is an effective treatment for many different types of acute and chronic liver disease. Many diseases recur following liver transplantation. This review provides an update in the latest clinical developments in recurrent disease after liver transplantation.Recent FindingsLow-dose corticosteroids are associated with a reduction in recurrent autoimmune hepatitis following liver transplantation. “De novo” autoimmune hepatitis should be considered and treated as a form of allograft rejection. Tacrolimus has been reported to increase the risk of recurrent primary scleros...
Source: Current Hepatitis Reports - February 21, 2020 Category: Infectious Diseases Source Type: research

The Role of Nutrition in the Pathogenesis and Treatment of Alcohol-Related Liver Disease
AbstractAbstractMalnutrition is increasingly being recognized as a poor prognostic factor in the realm of chronic liver disease, particularly among those individuals with end-stage liver disease undergoing transplant evaluation.Purpose of ReviewThe purpose of this review is to demonstrate how nutrition contributes to disease pathogenesis and whether improvements in nutrition can alter disease pathogenesis.Recent FindingsRecent findings reveal that the role of nutrition is multifaceted, primarily due to alterations in gut microbiota and cytokine release. Additionally, there is increasing data demonstrating that those with g...
Source: Current Hepatitis Reports - February 20, 2020 Category: Infectious Diseases Source Type: research

Accounting for the Placebo Effect and Optimizing Outcomes in Clinical Trials of Nonalcoholic Steatohepatitis (NASH)
AbstractPurpose of ReviewUnderstand the placebo effect and optimize the design of nonalcoholic fatty liver disease (NAFLD) clinical trials.Recent FindingsThe placebo effect on histologic outcomes and liver fat on MRI-based imaging has been assessed in a systematic review and meta-analysis, and three phase 3 studies have been reported. The placebo effect on improvement in the main histologic outcome was present in ~  25% of the patients. The placebo effect on components of the NAFLD activity index in trials using the magnetic resonance imaging proton density fat fraction and magnetic resonance spectroscopy as outcome...
Source: Current Hepatitis Reports - January 31, 2020 Category: Infectious Diseases Source Type: research

The Role of Vascular Injury and Congestion in the Pathogenesis of Cirrhosis: the Congestive Escalator and the Parenchymal Extinction Sequence
AbstractPurpose of ReviewCurrent research into the pathogenesis of cirrhosis is largely dominated by investigations of hepatocellular injury and fibrogenesis, mostly in short-term experimental models. Cirrhosis in the human evolves for decades with histologic features that are very different from the models studied, dominated by hepatic vein obstruction and congestion. This is a clue that the mechanisms operating in the human are different from those in most animal models.Recent FindingsThis paper presents an updated “vascular hypothesis” with previously unpublished observations that provide a more complete und...
Source: Current Hepatitis Reports - January 28, 2020 Category: Infectious Diseases Source Type: research

The Current Landscape of Systemic Therapies for Advanced Hepatocellular Carcinoma
AbstractPurpose of reviewAs the global burden of HCC continues to rise, there is an overwhelming need for new systemic therapies for the treatment of advanced-stage HCC. In this review, we explore the current landscape of approved therapies for intermediate-stage HCC after progression with locoregional therapy or in those who present with advanced-stage HCC not amenable to curative options.Recent findingsIn the last 10 years, several agents have been studied in the first and second-line treatment of HCC but failed to show clinical benefit. Between 2008 and 2016, sorafenib was the sole agent used in the treatment of advance...
Source: Current Hepatitis Reports - November 28, 2019 Category: Infectious Diseases Source Type: research

Update in Drug Development for Chronic HBV/HDV Infection
AbstractPurpose of ReviewChronic hepatitis D is the most severe form of viral hepatitis. Currently, no drug has been approved for its treatment and pegylated interferon alpha remains the only recommended therapy, with dismal efficiency and important side effects. This review summarizes the recent advances in drug development for chronic hepatitis D.Recent FindingsA better knowledge of virology of hepatitis D virus has led to the development of several drugs targeting different steps of the viral life cycle. Among them, bulevirtide (a viral entry inhibitor, formerly denominated as Myrcludex B), lonafarnib (a viral assembly ...
Source: Current Hepatitis Reports - November 27, 2019 Category: Infectious Diseases Source Type: research

Spectrum of Drug Induced Liver Injury Caused by Anabolic Androgenic Steroids Abuse
AbstractPurpose of ReviewPotent anabolic androgenic steroids (AAS) are often illegally present in commercially available body building supplements (BBS) and may cause drug induced liver injury (DILI) with different phenotypes.Recent FindingsAAS induced DILI typically presents with a prolonged cholestatic liver injury with pruritus and a typical enzyme pattern of elevated transaminases that rapidly fall as alkaline phosphatase slowly increases. Liver biopsy reveals bland cholestasis that usually does not have chronic sequalae. Pathophysiology is unknown and genetic variants in genes associated with cholestatic syndromes wer...
Source: Current Hepatitis Reports - November 26, 2019 Category: Infectious Diseases Source Type: research

Medical Approach for Weight Loss in Nonalcoholic Fatty Liver Disease
AbstractPurpose of ReviewNonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions due to obesity in the modern world. Although treatments are in development, weight loss remains the most definitive and impactful approach to treating this disease and with it the other multisystemic complications of obesity. In this review, we summarize the current medical therapies for weight loss in NAFLD, including patient evaluation, counseling, and incorporation of medications for obesity.Recent FindingsDespite need for weight loss as treatment for NAFLD, few achieve successful weight loss. Weight loss medications lead ...
Source: Current Hepatitis Reports - November 21, 2019 Category: Infectious Diseases Source Type: research

NAFLD in Women: Unique Pathways, Biomarkers, and Therapeutic Opportunities
AbstractPurpose of reviewIn this review article, we evaluate sex differences in the natural history of NAFLD and highlight distinct risk profiles of women with NAFLD, as well as unique treatment considerations and research gaps.Summary of FindingsReproductive factors, such as menopausal status, should be considered when evaluating NAFLD risk in women, as well as additional reproductive risk factors such as age at menarche, presence of polycystic ovary syndrome, and gestational diabetes. Women do appear to have lower risk for hepatocellular carcinoma from NASH, as well as lower mortality from NASH cirrhosis than men, althou...
Source: Current Hepatitis Reports - November 18, 2019 Category: Infectious Diseases Source Type: research

Extrahepatic Malignancies in Nonalcoholic Fatty Liver Disease
AbstractPurpose of ReviewMalignancy is the second most common cause of death in individuals with nonalcoholic fatty liver disease (NAFLD). Understanding unique characteristics of malignancy risk beyond hepatocellular carcinoma in NAFLD has significant implications in counseling and personalized preventative measures in this high-risk population. Herein, we systematically review the literature reporting extra-hepatic malignancies in NAFLD and discuss the key biological mechanisms underpinning the association between excess adiposity and cancer risk.Recent FindingsSeveral studies have shown significant associations between N...
Source: Current Hepatitis Reports - November 15, 2019 Category: Infectious Diseases Source Type: research

HIV-Associated NAFLD: Disease Burden and Management
AbstractPurpose of ReviewHighly potent anti-retroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) has led to dramatic improvements in quality of life and lifespan in persons living with HIV (PLWH). PLWH, however, are suffering from other comorbid conditions, including non-alcoholic fatty liver disease (NAFLD). This review summarizes the epidemiology and pathophysiology of NAFLD in PLWH and explores unique diagnostic and treatment considerations in this population.Recent FindingsThough it is well established that there is a high prevalence of NAFLD in PLWH, the mechanisms underlying NAFLD in this ...
Source: Current Hepatitis Reports - November 15, 2019 Category: Infectious Diseases Source Type: research

Quantification of Liver Fat in NAFLD: Available Modalities and Clinical Significance
AbstractPurpose of ReviewTo review the available modalities for quantification of liver fat in nonalcoholic fatty liver disease (NAFLD) and their clinical significance.Recent FindingsUltrasonography remains the first line imaging used to diagnose NAFLD as it is widely available and relatively inexpensive. Controlled attenuation parameter can be used as a screening tool for fatty liver as it is reasonably accurate and provides simultaneous estimation of hepatic fibrosis. Magnetic resonance imaging proton density fat fraction and magnetic resonance spectroscopy are the most accurate noninvasive modalities for quantification ...
Source: Current Hepatitis Reports - November 11, 2019 Category: Infectious Diseases Source Type: research

Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV
AbstractPurpose of ReviewTo review the evidence for stopping antiviral therapy with nucleos(t)ide analogues (NA) in patients with chronic hepatitis B.Recent FindingsHBsAg loss is usually stable even without anti-HBs seroconversion after stopping NA therapy. About 50% of HBeAg-positive patients who have achieved anti-HBe seroconversion and have stopped NA therapy remain in virological remission. Consolidation therapy increases the response rate. In HBeAg-negative hepatitis, stable virological remission is documented in 30% after NA discontinuation. Interestingly, some studies document unexpectedly high long-term HBsAg loss ...
Source: Current Hepatitis Reports - November 11, 2019 Category: Infectious Diseases Source Type: research

Should We Screen High-Risk Populations for NAFLD?
AbstractPurpose of reviewNonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide and yet remains largely underdiagnosed. However, whether a systematic screening in high-risk population for NAFLD should be performed remains debated.Recent findingsOver the past decade, a better knowledge of the natural history and epidemiology of NAFLD has identified high-risk population for NAFLD including obese and type 2 diabetes patients. Moreover, the presence of advanced fibrosis has been identified as the major determinant of overall and liver-related mortality. Moreover, several non-in...
Source: Current Hepatitis Reports - November 8, 2019 Category: Infectious Diseases Source Type: research

NAFLD Histology: a Critical Review and Comparison of Scoring Systems
AbstractPurpose of ReviewDespite the emergence of non-invasive tests, liver biopsy remains the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD). This review will provide an overview of the histology of adult NAFLD with a focus on current scoring systems, histologic features that predict clinical outcomes, and areas in need of improvement.Recent FindingsStudies during the last two decades have established the histologic features used to categorize NAFLD into non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), described histologic scoring systems that measure disease activit...
Source: Current Hepatitis Reports - November 4, 2019 Category: Infectious Diseases Source Type: research

Future Therapies for Functional Cure of Chronic HBV: Review of Investigational Drugs in Phase 1 and 2 Development
AbstractPurpose of ReviewTreating patients with chronic hepatitis B (CHB) infection with long-term oral antiviral therapy or pegylated interferon is the current standard of care (SOC). However, functional cure, defined as sustained hepatitis B surface antigen (HBsAg) seroclearance that is associated with favorable clinical outcomes, is a rarely achieved treatment endpoint with the SOC.Recent FindingsRemarkable advances in CHB therapy have been made in the recent years. This review was aimed to describe the different new treatment agents that are in the clinical phase of development. These include two main groups of agents ...
Source: Current Hepatitis Reports - November 1, 2019 Category: Infectious Diseases Source Type: research

Screening Indications and Treatments for Cholangiocarcinoma
AbstractPurpose of ReviewThe goal of this review paper is to provide a comprehensive overview of cholangiocarcinoma (CCA) including its classification, epidemiology, risk factors, surveillance, diagnosis, and treatment.Recent FindingsGuidelines recommend CCA surveillance in PSC patients with MRI/MRCP or ultrasound and CA 19-9 every 6 –12 months. Fluorescience in situ hybridization and next-generation sequencing improve the poor sensitivity of biliary brushings. Surgical resection with negative margins gives the best chance of survival, and liver transplantation is an option for patients with very early intrahepatic C...
Source: Current Hepatitis Reports - October 31, 2019 Category: Infectious Diseases Source Type: research

Liquid Biopsy for Hepatocellular Carcinoma
AbstractPurpose of ReviewClinically available biomarkers for hepatocellular carcinoma (HCC) early diagnosis and prognostication have limited utility. Further lack of routine biopsy in hepatocellular carcinoma limits the availability of molecular information to guide drug development. Recent studies investigating liquid biopsy using circulating tumor cells (CTCs) and cell-free deoxyribonucleic acid (cfDNA) have yielded promising data that could address both of these limitations.Recent FindingsFor early HCC diagnosis, CTCs have modest sensitivity but high specificity. CfDNA methylation scores have shown high sensitivity and ...
Source: Current Hepatitis Reports - October 29, 2019 Category: Infectious Diseases Source Type: research

Downstaging and Expanded Criteria Hepatocellular Carcinoma Liver Transplantation
AbstractPurpose of ReviewLiver transplantation (LT) has been utilized in the last two decades for the treatment of selected patients with hepatocellular carcinoma (HCC). Currently, in most jurisdictions worldwide, only tumor size and number determine transplant candidacy, which may not sufficiently predict tumor behavior. Both tumor downstaging and expanding transplant criteria play an important role in expanding access to LT for HCC patients.Recent FindingsNew downstaging protocols are emerging that incorporate response to locoregional therapies (LRT) among those that initially present beyond the accepted Milan criteria. ...
Source: Current Hepatitis Reports - October 22, 2019 Category: Infectious Diseases Source Type: research

Harms of Hepatocellular Carcinoma Surveillance
AbstractPurpose of ReviewHepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with decreased mortality by enabling early tumor detection. However, the benefits of any cancer screening program must be considered in light of potential physical, financial, and psychological harms, as well as the risk of overdiagnosis. Herein, we summarize the potential harms of HCC surveillance.Recent FindingsTo date, two retrospective studies have addressed physical harms of HCC surveillance. Based on these data, 15% to 28% of patients undergoing HCC surveillance experience physical harm including additional c...
Source: Current Hepatitis Reports - October 15, 2019 Category: Infectious Diseases Source Type: research

Correction to: Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma
The article Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma, written by Byung-Han Rhieu, Amol K. Narang and Jeffrey Meyer, was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on 16 October 2018 without open access. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - September 16, 2019 Category: Infectious Diseases Source Type: research

The Role of Traditional Chinese Medicines (TCM) and Other Complementary and Alternative Medicines (CAM) in the Management of Chronic Hepatitis B
AbstractPurpose of ReviewTo provide a review and update of complementary and alternative medicine (CAM) approaches to the management of chronic hepatitis B, with particular emphasis upon traditional Chinese medicines (TCM).Recent FindingsThe major findings are as follows: (1) TCMs were better than interferons [IFN] in lowering serum HBeAg and normalizing serum ALT, and equivalent to IFN in clearing serum HBV DNA; (2) TCMs were equivalent to lamivudine [LAM] in lowering serum HBeAg, normalizing serum ALT, and clearing serum HBV DNA; (3) TCMs along with IFN or LAM significantly lowered serum HBeAg and improved the clearance ...
Source: Current Hepatitis Reports - August 6, 2019 Category: Infectious Diseases Source Type: research

Strategies for Global Elimination of Chronic HBV Infection: 2019 Update
AbstractPurpose of ReviewWith just over a decade to go before the WHO 2030 hepatitis elimination targets, this review takes a global perspective at the major challenges standing in the way of hepatitis B virus (HBV) elimination and discusses potential innovative solutions on the horizon for use in high burden settings.Recent FindingsUniversal HBV infant vaccination has been an incredible success. However, in order to reach the elimination targets, efforts now need to urgently focus on scaling up HBV prevention of mother-to-child (PMTCT) interventions, particularly in sub-Saharan Africa and increasing population level testi...
Source: Current Hepatitis Reports - August 5, 2019 Category: Infectious Diseases Source Type: research

Drug-Induced Liver Injury Due to Nonsteroidal Anti-inflammatory Drugs
AbstractPurpose of ReviewNonsteroidal anti-inflammatory drugs (NSAIDs) are a heterogeneous group of medications intended to treat a variety of inflammatory diseases. While they are generally regarded as safe and most known for their potential gastrointestinal and renal side effects, cases of hepatotoxicity have been reported. This review summarizes the US and international literature regarding the incidence of NSAID-induced DILI and the biochemical signature of specific NSAIDs.Recent FindingsMultiple studies have identified diclofenac as one of the more common culprits of NSAID-induced DILI. A genetic predisposition to DIL...
Source: Current Hepatitis Reports - August 2, 2019 Category: Infectious Diseases Source Type: research

Role of HBsAg Testing in the Management of Patients with Chronic HBV
AbstractPurpose of ReviewHBsAg has been an important serological marker for the diagnosis of hepatitis B virus (HBV) infection. Recently, HBsAg quantification has been utilized to predict the disease activity and the response to antiviral treatment. This review aims to update the clinical utility of HBsAg quantification in the management of chronic hepatitis B (CHB).Recent FindingsHBsAg level varies across different phases of the natural history of CHB, highest in the immune-tolerant phase and lowest in inactive carriers. HBsAg level is useful to stratify the risk of hepatocellular carcinoma in low-viremic patients. HBsAg ...
Source: Current Hepatitis Reports - July 31, 2019 Category: Infectious Diseases Source Type: research

Epidemiology, Diagnosis, and Management of Bone Disease in Patients with Chronic HBV Infection
AbstractPurpose of ReviewChronic hepatitis B (CHB) and treatment may be associated with increased risk of osteopenia/osteoporosis. Here, we review the prevalence of osteopenia/osteoporosis among patients with CHB and the effect of antiviral therapy on bone density. We also highlight screening and management strategies for bone disease among patients with CHB.Recent FindingsWhile there are concerns with first-line antiviral therapy such as tenofovir disoproxil fumarate in the development of osteopenia/osteoporosis, the available data remain rather unclear. However, with the development of tenofovir alafenamide, these concer...
Source: Current Hepatitis Reports - July 31, 2019 Category: Infectious Diseases Source Type: research

The Role of Liver Biopsy in Drug-Induced Liver Injury
AbstractPurpose of ReviewThis review presents the current understanding of the role played by liver biopsy in the diagnosis and management of drug-induced liver injury (DILI).Recent FindingsWhile liver biopsy remains an optional procedure in the evaluation of DILI, it has the potential to provide detailed information about the state of the liver. Recent histological surveys of DILI provide a framework for categorizing the patterns of injury that may be seen. Pattern information can be used to distinguish DILI from other potential causes of injury, both other acute injuries as well as pre-existing injury. The pattern of inj...
Source: Current Hepatitis Reports - July 30, 2019 Category: Infectious Diseases Source Type: research