Is Exercise Beneficial and Safe in Patients with Cirrhosis and Portal Hypertension?
AbstractPurpose of ReviewIn spite of the many health benefits attributed to exercise, reports summarizing the literature in patients with cirrhosis are scarce. We aimed to provide a comprehensive review focusing on potential safety considerations in cirrhosis.Recent FindingsDiminished exercise capacity in patients with cirrhosis worsens their prognosis before and after liver transplantation. Exercise poses unique challenges in this population, raising questions of safety —worsening portal hypertension and malnutrition—and efficacy. In this review, we show that the balance of evidence supports supervised exercise progra...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Drug-Induced Liver Injury in Children
AbstractPurpose of ReviewDrug-induced liver injury (DILI) is relatively rare among children but can cause substantial morbidity and mortality. Here, we summarize the literature on pediatric DILI including a focus on commonly used classes of drugs.Recent FindingsThe incidence of pediatric DILI remains poorly defined. Antimicrobials and antiepileptic medications are the most commonly reported causes of pediatric idiosyncratic DILI in the US DILI network (DILIN) experience. DILI among children being treated for cancer appears to be underreported, and recent literature clearly implicates newer classes of agents such as tumor n...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
The Role of Anticoagulation in Treating Portal Hypertension
AbstractPurpose of ReviewTo revise experimental and clinical data supporting a less traditional role of anticoagulation for treating portal hypertension in patients with cirrhosis.Recent FindingsPortal hypertension is the main driver of complications such as ascites, variceal hemorrhage, and hepatic encephalopathy, with inflammation as a key component. The traditional view of cirrhosis as a pro-hemorrhagic condition has recently changed, prothrombotic complications being recognized as frequently as the hemorrhagic ones. Several data indicate a close relationship between inflammation, prothrombotic status, worsening of hepa...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Drug-Induced Liver Injury: Understanding the Different Immune-Mediated Phenotypes and Clinical Management
AbstractPurpose of ReviewThe aim of this manuscript is to review two immune-mediated drug-induced liver injury (DILI) phenotypes, immune-allergic DILI (IA-DILI) and DILI with autoimmune hepatitis features (DILI-AIH), which are poorly defined and can lead to significant morbidity and mortality.Recent FindingsRecent information on this topic improves the understanding of IA-DILI and DILI-AIH regarding risk factors, associated medications, clinical presentations, histopathologic findings, and management strategies.SummaryAlthough the pathogenesis and specific mechanisms remain elusive, clinical and pathological advancements i...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
The Portosystemic Shunt Syndrome and Role of Shunt Embolization in the Management of Hepatic Encephalopathy
AbstractPurpose of ReviewPortosystemic shunting (PSS) is a result of changes in hepatic hemodynamics where portal flow diverts away from the liver due to increased intrahepatic resistance from cirrhosis and is associated with hepatic encephalopathy (HE). Over time, increased PSS may directly lead to worsening liver failure because of severely decreased loss of effective portal inflow towards the liver and result in recurrent or persistent HE. This clinical scenario has been recently defined as “portosystemic shunt syndrome” and has been associated with poor clinical outcomes.Recent FindingsThe presence of PSS is common...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Novel Approaches to Causality Adjudication in Drug-Induced Liver Disease
AbstractPurpose of ReviewDrug-induced liver injury (DILI) is a complex diagnosis dominantly based of exclusion.Recent FindingsCurrently available causality assessment instruments are considered to be suboptimal. Expert opinion appears to be best method to adjudicate causality, but is impractical to implement on a wide scale basis. Thus, new approaches are needed, for example, improving the specificity of current scoring systems. A further option would be to develop a system that utilizes computer-based scoring —which would reduce human error. Additionally, it would be ideal to have available drug-specific scoring systems...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Beware of HCV and HEV in Patients with Suspected Drug-Induced Liver Injury
AbstractPurpose of ReviewWithout a specific biomarker, the diagnosis of drug-induced liver injury (DILI) relies on exclusion of other causes of liver injury. This review examines the importance of testing for hepatitis C (HCV) and hepatitis E (HEV) in patients with suspected DILI.Recent FindingsSeveral national DILI registries have reported HCV and HEV infection in patients initially diagnosed with DILI. Particularly in patients with suspected DILI who have acute hepatocellular liver injury, acute HCV and acute HEV infection should be considered even in the absence of traditional risk factors. For HCV infection, testing fo...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Innovative Care Models in Liver Disease: the Role of Multidisciplinary Teams
AbstractPurpose of ReviewPatients with chronic liver disease have diverse healthcare and psychosocial needs across a multitude of care domains. Incorporation of multidisciplinary teams (MDT) enhances care coordination between physician, patient, and other healthcare providers.Recent FindingsA MDT approach may be beneficial to provide comprehensive care for all cirrhotics. MDT are successfully used for management of hepatocellular carcinoma and evaluating candidacy for liver transplantation (LT). Among patients with alcoholic liver disease, lower rates of post LT recidivism are observed with MDT. The Practice Guide on Obesi...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Portal Hypertension Reverses Following Successful Antiviral Treatment for HCV: Fact or Fiction?
AbstractPurpose of ReviewThe development of portal hypertension has relevant implications in the natural history of patients with hepatitis C-related liver disease. Indeed, when the hepatic venous pressure gradient is ≥ 10 mmHg (clinical significant portal hypertension—CSPH), the risk of decompensation, hepatocellular carcinoma, or death markedly increases.Recent FindingsThe achievement of sustained virological response (SVR) has been associated with a reduction in portal pressure. The use of all-oral antiviral regimens allows treating patients with more advanced liver disease (CSPH or decompensated). However, curre...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Knowns and Unknowns: the Safety and Efficacy of Cancer Immunotherapy in Chronic Liver Disease
(Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Uncommon Presentations of Idiosyncratic Drug-Induced Liver Injury
AbstractPurpose of ReviewIdiosyncratic drug-induced liver injury (DILI) typically presents acutely with liver test abnormalities, sometimes with associated symptoms of abdominal pain, nausea, vomiting, jaundice, fevers, and rash. Histologic abnormalities in such cases of DILI typically range from lobular or portal hepatitis to hepatocyte necrosis. However, sometimes the drug-related liver injuries present with clinical and/or histological features atypical of garden variety DILI and they may be related to uncommon mechanisms of injury, histologic features, or clinical presentation.Recent FindingsMultiple agents or classes ...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Long-Term Outcomes After Drug-Induced Liver Injury
AbstractPurpose of the ReviewThis review serves to update the reader on emerging data regarding a spectrum of drug-induced liver injury (DILI) outcomes that lie between complete resolution and acute liver failure. Such outcomes can range from mild chronic injury to late liver failure and mortality.Recent FindingsSeveral large registries are maturing with large numbers of DILI cases thus shedding light on outcomes including chronic injury and late fatality. We cover definitions commonly used to describe resolution versus chronic injury and mortality due to DILI. We look at rates of occurrence for these different outcomes in...
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
Correction: Assessment and Management of Sleep Disturbance in Cirrhosis
The article Assessment and Management of Sleep Disturbance in Cirrhosis, written by Chiara Formentin, Maria Garrido, and Sara Montagnese, was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on 13 February 2018 without open access. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - September 1, 2018 Category: Infectious Diseases Source Type: research
The Portosystemic Shunt Syndrome and Role of Shunt Embolization in the Management of Hepatic Encephalopathy
AbstractPurpose of ReviewPortosystemic shunting (PSS) is a result of changes in hepatic hemodynamics where portal flow diverts away from the liver due to increased intrahepatic resistance from cirrhosis and is associated with hepatic encephalopathy (HE). Over time, increased PSS may directly lead to worsening liver failure because of severely decreased loss of effective portal inflow towards the liver and result in recurrent or persistent HE. This clinical scenario has been recently defined as “portosystemic shunt syndrome” and has been associated with poor clinical outcomes.Recent FindingsThe presence of PSS is common...
Source: Current Hepatitis Reports - July 23, 2018 Category: Infectious Diseases Source Type: research
Drug-Induced Fatty Liver Disease
AbstractPurpose of ReviewDrug-induced fatty liver disease (DIFLD) is one of the manifestations of drug-induced liver injury (DILI) based on histopathology findings of steatosis or steatohepatitis. DIFLD has high semblance to nonalcoholic fatty liver disease (NAFLD), where similar histopathological features are seen. As NAFLD is a commonly occurring disease, differentiating DIFLD from NAFLD requires a thorough history of medication use. Outcomes in DIFLD vary with the clinical presentation, with extremely high mortality in acute fatty liver presentations and indolent course in the rest. Pathophysiology in almost all cases o...
Source: Current Hepatitis Reports - July 21, 2018 Category: Infectious Diseases Source Type: research
