The Use of Biologics in Patients with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis
AbstractPurpose of ReviewBiologics are well established in the treatment of many immuno-inflammatory diseases including inflammatory bowel disease (IBD). However, although primary sclerosing cholangitis (PSC) is closely associated with IBD, the role of biologics in PSC remains uncertain. Many new biologics are becoming available to treat IBD, and this review aims to use the experience of biologics in PSC so far to guide more effective evaluation of emerging therapies in the future.Recent FindingsAntibodies to TNF- α were the first biologics used in IBD, and retrospective analysis suggests that they may have some benefit i...
Source: Current Hepatitis Reports - March 6, 2019 Category: Infectious Diseases Source Type: research
Future Pharmacological Therapies of Portal Hypertension
AbstractPurpose of ReviewTo provide an overview of recent pharmacological treatments for portal hypertension evaluated in early clinical trials, with particular emphasis on the pathophysiological basis of their use.Recent FindingsIn patients with compensated cirrhosis, even small decreases in portal pressure (as small as 1 mmHg) are associated with a lower probability of decompensation. In patients with decompensated cirrhosis, portal pressure “response” to non-selective beta-blocker (NSBB) therapy is associated with a lower mortality. When present, significant portal hypertension persists even after the elimina tion...
Source: Current Hepatitis Reports - February 19, 2019 Category: Infectious Diseases Source Type: research
Portal Hypertension after Liver Transplantation —Causes and Management
AbstractPurpose of ReviewWhile portal hypertension (PHT) treatment strategies for patients with advanced chronic liver disease (ACLD) are well established, studies on the management of PHT after orthotopic liver transplantation (OLT) are limited. This is due to the heterogeneous causes of portal hypertension in the OLT setting.Recent FindingsSpecific recommendations for the management of non-alcoholic steatohepatitis (NASH), including medical and surgical therapeutic options, and hepatitis C virus (HCV) infection after OLT, are available with most of them applying to transplanted patients. Important concepts to prevent and...
Source: Current Hepatitis Reports - February 13, 2019 Category: Infectious Diseases Source Type: research
Future Medical Treatment of PSC
AbstractPurpose of ReviewPrimary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by inflammation of intrahepatic and/or extrahepatic bile ducts leading to stricturing, biliary fibrosis, cirrhosis, and liver failure. PSC is highly associated with inflammatory bowel diseases (IBD) and bears significant risk for cholangiocellular and colorectal cancer. To date, no medical treatment has been proven in randomized controlled trials to improve transplant-free and overall patient survival. However, numerous innovative therapeutic concepts are currently tested in phase 2 to phase 3 clinical trials. Base...
Source: Current Hepatitis Reports - February 13, 2019 Category: Infectious Diseases Source Type: research
Obscure Gastrointestinal Bleeding in Cirrhosis: Work-up and Management
AbstractPurpose of ReviewObscure gastrointestinal bleeding (OGIB) in patients with cirrhosis can be a diagnostic and therapeutic challenge. Recent advances in the approach and management of this group of patients can help to identify the source of bleeding. While the work-up of patients with cirrhosis and OGIB is the same as with patients without cirrhosis, clinicians must be aware that there are conditions exclusive for patients with portal hypertension that can potentially cause OGIB.Recent FindingsNew endoscopic and imaging techniques are capable to identify sources of OGIB. Balloon-assisted enteroscopy (BAE) allows dir...
Source: Current Hepatitis Reports - February 12, 2019 Category: Infectious Diseases Source Type: research
TIPS Indications and Contraindications —Pushing the Limits: Is Earlier Better?
AbstractPurpose of ReviewTo describe the main indications and contraindications of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with portal hypertension (PH).Recent FindingsAn adequate selection of patients helps to identify those who may benefit from TIPS in terms of survival. In patients with acute variceal bleeding and factors of poor prognosis, a pre-emptive use of TIPS is associated with significant reductions in treatment failure and mortality. Similarly, TIPS has shown to improve survival in a highly selected group of patients with cirrhosis and refractory ascites.SummaryPH is a clinica...
Source: Current Hepatitis Reports - February 8, 2019 Category: Infectious Diseases Source Type: research
The Role of Fibrates in Primary Biliary Cholangitis
AbstractPurpose of ReviewUrsodeoxycholic acid (UDCA) is recognized worldwide as the standard of care of primary biliary cholangitis (PBC). Obeticholic acid and fibrates have recently shown the potential to further improve the biochemical markers of PBC. The purpose of this review is to discuss more specifically the role of fibrates in PBC.Recent FindingsThe BEZURSO trial (Phase 3 Study of Bezafibrate in Combination With Ursodeoxycholic Acid in Primary Biliary Cholangitis) is the first ever placebo-controlled trial of a fibrate in PBC. In this 24-month study, second-line use of bezafibrate in addition to continued UDCA resu...
Source: Current Hepatitis Reports - February 7, 2019 Category: Infectious Diseases Source Type: research
Predicting Future Complications of Cirrhosis
AbstractPurpose of ReviewDecompensated cirrhosis and liver failure result in high mortality risk. Identifying the severity of illness and risk of poor outcomes is important for improved clinical decision making. This review serves to examine the currently in practice and developing tools for prognosticating patients with cirrhosis.Recent FindingsThe Child –Turcotte–Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score are the most used prognostic tools for cirrhotic patients. More recently, however, are newly developing biochemical models and imaging tools that strive to improve upon the MELD score.Summar...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research
Liver Involvement after a Fontan Procedure for Congenital Heart Disease
AbstractPurpose of ReviewPatients with congenital heart disease are living longer into adulthood. As these patients age, we see extracardiac complications of Fontan circulation. Liver dysfunction is almost universal in patients who have had a Fontan surgery. This paper seeks to describe the current understanding of the pathophysiology, diagnosis, and management of Fontan-associated liver dysfunction (FALD).Recent FindingsIn this era of noninvasive markers for liver diseases, unfortunately, these markers have been found to be less sensitive in patients with FALD. There have been small, mostly single center, reports about th...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research
Multidrug-Resistant Bacterial Infection in Patients with Cirrhosis. A Review
AbstractPurpose of ReviewThe burden of multidrug resistance has become one of the world ’s most urgent public health problems. Patients with infection caused by multidrug-resistant organisms (MDROs) have an increased risk for worse outcomes and death.Recent FindingsCirrhotic patients, mostly decompensated, are prone to developing infections caused by MDROs, particularly because they are in close contact with healthcare settings. During the last two decades, the first-line therapies recommended to treat infections in cirrhotic patients have become progressively less effective. Early identification of patients at high risk...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research
Non-invasive Measurement of Portal Pressure
AbstractPurpose of ReviewTo provide an updated overview of the existing and emerging non-invasive diagnostic methods to assess portal hypertension.Recent FindingsData on liver stiffness measurement confirmed that it is a mainstay for assessing the risk of clinically significant portal hypertension in patients with advanced chronic liver disease of any etiology. The Baveno criteria for identifying patients who can safely spare endoscopy have been validated in NASH and cholestatic liver disease. New expanded criteria and other simple non-invasive algorithms including MELD score or spleen stiffness have been proposed and can ...
Source: Current Hepatitis Reports - February 2, 2019 Category: Infectious Diseases Source Type: research
Overcoming Alcohol Addiction in Patients with Alcohol-Related Liver Disease
AbstractPurpose of ReviewThis review provides a brief overview of key concepts in addiction medicine and provides tips and tricks as it pertains to treating patients with alcohol addiction in the setting of advanced alcohol-related liver disease (ALD).Recent FindingsUnderstanding the brain disease model of addiction by both providers and patients is a vital springboard for establishing a therapeutic relationship. Despite a paucity of high-quality evidence, psychosocial treatments have withstood the test of time and still form the foundation of alcohol use disorder (AUD) treatment in advanced ALD. Despite the inescapable li...
Source: Current Hepatitis Reports - January 31, 2019 Category: Infectious Diseases Source Type: research
Prevention and Management of Hepatitis B in Healthcare Professionals
AbstractPurpose of ReviewTo review the epidemiology of hepatitis B virus (HBV) transmission in the healthcare setting and outline best practices in the prevention and management of chronic HBV in healthcare professionals.Recent FindingsHepatitis B virus (HBV) infection remains a global public health burden and chronically infects an estimated 257 million persons worldwide. HBV represents one of the most important occupational risks for healthcare workers (HCWs) due to efficient transmission through percutaneous exposure of HBV-infected blood and blood-contaminated body fluids. Although the incidence of HCW-patient transmis...
Source: Current Hepatitis Reports - January 28, 2019 Category: Infectious Diseases Source Type: research
Cirrhosis and Autoimmune Liver Disease
AbstractPurpose of ReviewAutoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) constitute the most frequently observed forms of autoimmune liver diseases. Each of these autoimmune liver diseases might present with cirrhosis at diagnosis, and a significant proportion of patients develop cirrhosis during follow-up. This manuscript provides a review that addresses how to monitor and manage patients with cirrhosis secondary to autoimmune liver diseases.Recent FindingsFor patients with PBC, the farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), is the first approved dru...
Source: Current Hepatitis Reports - January 28, 2019 Category: Infectious Diseases Source Type: research
Surgical Issues in NASH: Bariatric Surgery and Liver Transplantation
AbstractPurpose of ReviewThe rising prevalence of obesity in general and non-alcoholic steatohepatitis (NASH) specifically as an indication for liver transplantation has occurred in parallel with an increase in the consideration and performance of bariatric surgery before and after liver transplantation. We review the impact and relative merits of bariatric surgery before, during, and after liver transplantation.Recent FindingsThe sleeve gastrectomy approach has several practical advantages over other forms of weight loss surgery and has been shown to improve metabolic parameters. Bariatric surgical procedures inevitably a...
Source: Current Hepatitis Reports - November 21, 2018 Category: Infectious Diseases Source Type: research
