Liver and Brain Disorders
AbstractPurpose of ReviewThis review provides a concise update on recent developments in liver and brain interactions traversing encephalopathy in acute, acute on chronic liver failure, and non-cirrhotic liver disease.Recent FindingsAn interconnected axis of gut-microbiota changes, systemic inflammation, and mediators of neuroinflammation impact liver-brain interaction. Encephalopathy in acute on chronic liver failure has its own trajectories. Newer drugs and techniques show promise, while established therapies have newer indications.SummaryNeurogliovascular unit dysfunction and cross-talk abnormalities play an important r...
Source: Current Hepatitis Reports - April 2, 2024 Category: Infectious Diseases Source Type: research
Outcomes in Cirrhosis-Related Refractory Ascites with Emphasis on Palliative Care: Single-Centre Experience and Literature Review
AbstractPurpose of ReviewDespite refractory ascites (RA) due to cirrhosis having a median transplant-free survival of 6 –12 months, palliative care (PC) input remains uncertain. We aimed to review the existing literature on clinical outcomes in cirrhosis-related RA and report the findings of a single-centre retrospective cohort study with a special focus on linkage to PC in this cohort of patients.Recent FindingsOur study and subsequent literature review confirm the high mortality associated with cirrhosis-related RA (19 –55% 1-year mortality) with only a minority of patients receiving curative options (3–23%). Desp...
Source: Current Hepatitis Reports - April 2, 2024 Category: Infectious Diseases Source Type: research
Primary Biliary Cholangitis: Updates in Management and Goals of Treatment
AbstractPurpose of ReviewPrimary biliary cholangitis (PBC) is a chronic autoimmune disease of the liver characterized by cholestasis and destruction of bile ducts. Goals of treatment include normalization of liver enzymes and prevention of progression to cirrhosis as well as symptom control. The purpose of this review is to summarize the current state of treatment of primary biliary cholangitis.Recent FindingsIn 2021, AASLD released a statement recommending fibrates as an off-label alternative for PBC patients with inadequate response or contraindications to approved therapies. Caution should be used when considering OCA i...
Source: Current Hepatitis Reports - March 27, 2024 Category: Infectious Diseases Source Type: research
The Role of Laparoscopic Surgery in the Management of Hepatocellular Carcinoma
This article reviews the role of laparoscopy in the multi-disciplinary management of HCC.Recent FindingsLaparoscopic surgery involves multiple approaches for diagnosis and treatment of HCC, including intraoperative ultrasound and biopsy, as well as ablative strategies for tumors in difficult locations. In comparison to catheter-based therapies, hepatic resection offers similar survival with the benefit of direct visualization to identify additional tumors. Laparoscopic liver resections further show similar oncologic outcomes with reduced hospital length of stay and reduced morbidity compared to open approaches and may even...
Source: Current Hepatitis Reports - March 22, 2024 Category: Infectious Diseases Source Type: research
Hepatocellular Carcinoma in the Era of Direct Antiviral Agents Against Hepatitis C Virus
AbstractPurpose of ReviewThe hepatitis C virus (HCV) is a major cause of liver-related morbidity and mortality, and a major risk factor of hepatocellular carcinoma (HCC) around the world. Early detection, continued prevention of transmission, and antiviral treatment of chronically infected persons are the pillars to decrease incidence and mortality of HCV. The widespread access to safe and effective direct acting anti-viral agents (DAA) has allowed the elimination of the infection possible in almost all treated patients, thus leading to a significant reduction of liver-related and overall mortality due to HCV in the cured ...
Source: Current Hepatitis Reports - March 18, 2024 Category: Infectious Diseases Source Type: research
Acute Kidney Injury in Acute on Chronic Liver Failure Versus Decompensated Cirrhosis —What Is the Difference?
AbstractPurpose of ReviewHepatorenal syndrome (HRS), the severe manifestation of renal injury in patients with cirrhosis and acute on chronic liver failure (ACLF), is characterized by decreased renal blood flow and glomerular filtration rate. Manuscript will elaborate how acute kidney injury (AKI) is different in ACLF and cirrhosis.Recent FindingsWe have role of biomarkers in differentiating HRS AKI from chronic kidney disease (CKD) in cirrhosis as well as ACLF patients. Medical therapy, timing of extracorporeal therapies, and role of liver transplant in patients of cirrhosis and ACLF.SummaryACLF patients usually have stru...
Source: Current Hepatitis Reports - March 11, 2024 Category: Infectious Diseases Source Type: research
An Overview of the Clinical Implications of Cirrhotic Cardiomyopathy
AbstractPurpose of ReviewCirrhotic cardiomyopathy (CCM) is a clinical entity that reflects the maladaptive responses of the heart to advanced chronic liver disease. With the recent developments in this field, this review details the most up to date knowledge about the pathogenesis of CCM, recent changes in its diagnostic criteria, and its clinical relevance.Recent FindingsAdvances in echocardiographic techniques over the last several years and recent research have highlighted the high prevalence of CCM approaching 35% and demonstrated adverse impact of CCM on clinical outcomes following transjugular intrahepatic portosyste...
Source: Current Hepatitis Reports - March 8, 2024 Category: Infectious Diseases Source Type: research
AIH Therapy: Beyond First-Line
AbstractPurpose of ReviewThe purpose of the article is to review treatment options for patients with AIH for whom first-line therapy is not successful. We outline recommended approaches for providers and new therapies on the horizon.Recent FindingsBudesonide, while advantageous in some respects, may not be as effective as predniso(lo)ne. Mycophenolate mofetil is most effective in the setting of azathioprine intolerance and less effective when the response to azathioprine has been inadequate. Infliximab is the biologic agent with the most evidence for use in AIH. Clinical trials studying interleukin 2, regulatory T cells, i...
Source: Current Hepatitis Reports - March 8, 2024 Category: Infectious Diseases Source Type: research
Systemic Disease and Portal Hypertension
AbstractPurpose of ReviewThe development of portal hypertension is typically a consequence of liver cirrhosis due mainly to primary liver disorders, whereas non-cirrhotic portal hypertension (NCPH) can be a complication of systemic, primarily extrahepatic diseases. Our purpose was to review the various systemic disorders leading to portal hypertension and provide a pathway for diagnosis and management.Recent FindingsNon-cirrhotic portal hypertension is a heterogeneous group of liver disorders primarily of vascular origin that may manifest as portal hypertension. The diagnosis of NCPH in the setting of systemic diseases is ...
Source: Current Hepatitis Reports - March 4, 2024 Category: Infectious Diseases Source Type: research
A Review of Hepatitis B Reactivation Risk on Immunosuppressants with a Focus on Newer Immunomodulators
AbstractPurpose of ReviewHepatitis B virus reactivation (HBVr) can complicate the use of immunosuppressive, antiviral, and chemotherapeutic medications in individuals with a history of prior exposure to HBV or chronic infection. Timely management is crucial to prevent fatalities. This review focuses on the various classes of biologics linked to the risk of HBVr, with emphasis on newer immunosuppressive and immunomodulator therapies.Recent FindingsImmune checkpoint inhibitors, tyrosine kinase inhibitors, cytokine inhibitors, and chimeric antigen receptor T-cell immunotherapies are associated with a high risk of hepatitis B ...
Source: Current Hepatitis Reports - February 28, 2024 Category: Infectious Diseases Source Type: research
Role of Vibration-Controlled Transient Elastography in the Evaluation and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease
AbstractPurpose of ReviewThe increasing global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) underscores the urgent need for a reliable non-invasive test (NIT) to phenotype and stratify risk in affected individuals. This narrative review aims to provide clinicians with an understanding of vibration-controlled transient elastography (VCTE). We focus on the clinical significance of key VCTE-derived parameters: the controlled attenuation parameter (CAP), liver stiffness measurement (LSM), and spleen stiffness measurement (SSM).Recent FindingsVCTE enables simultaneous assessment of hepatic stea...
Source: Current Hepatitis Reports - February 28, 2024 Category: Infectious Diseases Source Type: research
Management of Hepatitis B in Pregnancy
AbstractPurpose of ReviewIn 2016, WHO sets a target to eliminate viral hepatitis as a public health threat by 2030, with significant emphasis placed on reducing MTCT of HBV, which is the leading cause of CHB worldwide. In this review, we discuss the most recent recommendations in the literature on the management of HBV in pregnancy, including treatment considerations during pregnancy and recommendations for infant management, to reduce the MTCT of HBV.Recent FindingsRecent research advancements have focused on further unraveling the safety and efficacy of treatment options during pregnancy, developing more accessible postn...
Source: Current Hepatitis Reports - February 26, 2024 Category: Infectious Diseases Source Type: research
Cholestatic Pruritus: Pathophysiology, Current Management Approach, and Emerging Therapies
This article aims to illustrate the burden of cholestatic pruritus, review the proposed mechanisms, and summarize its available and emerging therapies.Recent FindingsPruritus is experienced by many patients with cholestatic liver diseases. It is underdiagnosed and negatively impacts patients ’ quality of life. Its direct cause remains unclear though multiple pathways have been explored. Current therapies are insufficient but newly approved ileal bile acid transporter (IBAT) inhibitors and emerging peroxisome proliferator-activated receptor (PPAR) agonists are promising.SummaryCholestatic pruritus affects many patients wi...
Source: Current Hepatitis Reports - February 26, 2024 Category: Infectious Diseases Source Type: research
When to Stop Antiviral Therapy in HBeAg-Negative Patients with Chronic Hepatitis B?
AbstractPurpose of ReviewThe strategy of finite nucleos(t)ide analogue (Nuc) therapy in HBeAg-negative patients has been increasingly accepted globally, and when to stop therapy has become an important issue. This review aimed to address this issue.Recent FindingsThe incidence of off-therapy relapse is lower with lower end-of-therapy (EOT) HBsAg level. Pretherapy HBV DNA < 20,000 IU/mL, on-treatment HBV DNA undetectable by week 12, treatment duration > 3 years, on-treatment HBsAg decline > 1 log10 IU/mL, and EOT HBsAg < 100 IU/mL are also factors for increasing off-therapy HBsAg loss. O...
Source: Current Hepatitis Reports - February 23, 2024 Category: Infectious Diseases Source Type: research
Indication of Liver Transplant for HCC: Current Status and Future Directions
AbstractPurpose of ReviewLiver transplantation remains the gold-standard treatment for cirrhotic patients with early stage, surgically unresectable hepatocellular carcinoma (HCC). In this review, we describe the current state of liver transplantation (LT) for HCC.Recent FindingsWe review recent advances in expanded indications for LT, diagnostics with liquid biopsy and biomarkers, and the emerging role of immunotherapy in this patient population.SummaryAlthough the shortage of liver allografts necessitates a restrictive HCC selection policy, future advances in patient selection, liquid biopsy technologies and systemic ther...
Source: Current Hepatitis Reports - February 22, 2024 Category: Infectious Diseases Source Type: research
