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 23, 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 21, 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 20, 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 20, 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 17, 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 currently...
Source: Current Hepatitis Reports - April 15, 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 4, 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 2, 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 28, 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 24, 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 sclerosing chol...
Source: Current Hepatitis Reports - February 20, 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 19, 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 outcomes als...
Source: Current Hepatitis Reports - January 30, 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 understandi...
Source: Current Hepatitis Reports - January 27, 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 27, 2019 Category: Infectious Diseases Source Type: research
