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cirrhosis guidelines

Sylvie Deuffic-Burban, Jérôme Boursier, Vincent Leroy, Yazdan Yazdanpanah, Laurent Castera, Philippe Mathurin
BACKGROUND AND AIMS: This study quantifies the impact of different rules for access to treatment, ranging from targeted therapy in patients with ⩾F3 in Italy, ⩾ severe F2 in France, and universal therapy in UK, using noninvasive diagnostic tests of fibrosis to determine targeted therapy. METHODS: A country-specific Markov model predicts outcomes with targeted and universal interferon-free therapy vs. no treatment in the three countries. Targeted therapy was initiated in patients ⩾F2 (F2-scenario) or ⩾F3 (F3-scenario) evaluated by noninvasive diagnostic tests according to the real stage of fibrosis...
October 12, 2016: Journal of Hepatology
Chaeyoun Oh, Joong Kee Youn, Ji-Won Han, Gi Beom Kim, Hyun-Young Kim, Sung-Eun Jung
INTRODUCTION: The Fontan procedure (FP) has become the standard operation for patients with single ventricle physiology. However, a long period of elevated systemic venous pressure and low cardiac output after the procedure result in chronic inflammation and liver cirrhosis, which may eventually lead to the occurrence of hepatocellular carcinoma (HCC). CLINICAL FINDINGS: We described the case of a 16-year-old female who developed HCC after the FP. At 21 months, the patient received a lateral tunnel FP, and 14 years later, she began complaining of abdominal distension, telangiectasia, and fatigue...
October 2016: Medicine (Baltimore)
Rianne A Weersink, Margriet Bouma, David M Burger, Joost P H Drenth, Nicole G M Hunfeld, Minke Kranenborg, Margje H Monster-Simons, Sandra A W van Putten, Herold J Metselaar, Katja Taxis, Sander D Borgsteede
INTRODUCTION: Liver cirrhosis can have a major impact on drug pharmacokinetics and pharmacodynamics. Patients with cirrhosis often suffer from potentially preventable adverse drug reactions. Guidelines on safe prescribing for these patients are lacking. The aim of this study is to develop a systematic method for evaluating the safety and optimal dosage of drugs in patients with liver cirrhosis. METHODS AND ANALYSIS: For each drug, a six-step evaluation process will be followed...
October 12, 2016: BMJ Open
(no author information available yet)
BACKGROUND: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. METHODS: We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010...
October 8, 2016: Lancet
Annick Vanclooster, Hub Wollersheim, Kris Vanhaecht, Dorine Swinkels, Bert Aertgeerts, David Cassiman
BACKGROUND: HFE-related hereditary haemochromatosis (HH) is a common autosomal recessive disorder with clinical manifestations ranging from asymptomatic disease to possible life-threatening complications. Cirrhosis, hepatocellular carcinoma, diabetes mellitus or osteoporosis can develop in HH patients not treated or monitored optimally. The purpose of this study was to develop key-interventions (KI's) to measure and improve the quality of care delivered to patients diagnosed with HH. METHODS: A RAND-Modified Delphi method was used to develop KI's...
October 13, 2016: BMC Health Services Research
Gamal Shiha, Alaa Ibrahim, Ahmed Helmy, Shiv Kumar Sarin, Masao Omata, Ashish Kumar, David Bernstien, Hitushi Maruyama, Vivek Saraswat, Yogesh Chawla, Saeed Hamid, Zaigham Abbas, Pierre Bedossa, Puja Sakhuja, Mamun Elmahatab, Seng Gee Lim, Laurentius Lesmana, Jose Sollano, Ji-Dong Jia, Bahaa Abbas, Ashraf Omar, Barjesh Sharma, Diana Payawal, Ahmed Abdallah, Abdelhamid Serwah, Abdelkhalek Hamed, Aly Elsayed, Amany AbdelMaqsod, Tarek Hassanein, Ahmed Ihab, Hamsik GHaziuan, Nizar Zein, Manoj Kumar
Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated...
October 6, 2016: Hepatology International
H Becker, J T Stahmeyer, M P Manns, C Krauth, M Cornberg
Infections with hepatitis B-, C- and D- viruses have a significant health burden. In Germany, the seroprevalence of HBs-Ag is calculated with 0.6 % and of HCV-antibodies with 0.3 %. However, most patients are not diagnosed. Sequelae are liver-cirrhosis and hepatocellular carcinoma. Several S3-guidelines for the diagnosis and treatment of viral hepatitis have been established. However, implementation of guidelines is not easy to evaluate. To estimate the changes of medical knowledge and diagnostic procedures about viral hepatitis, 7 parameters of liver-diagnostics were elected to analyze the requirements profile in the years 2005 - 2011 in 4 German federal states...
October 6, 2016: Zeitschrift Für Gastroenterologie
Roman Kloeckner, Daniel Pinto Dos Santos, Karl-Friedrich Kreitner, Anne Leicher-Düber, Arndt Weinmann, Jens Mittler, Christoph Düber
BACKGROUND: Arterial hyperenhancement and washout on computed tomography and magnetic resonance imaging (MRI) are described by all major guidelines as specific criteria for non-invasive diagnosis of hepatocellular carcinoma (HCC). However, publications on the quantitative assessment of washout in MRI are lacking. Therefore, we evaluated a method for quantitatively measuring and defining washout in MRI in order to determine a cutoff value that allows objective HCC diagnosis. METHODS: We analyzed all patients who underwent liver transplantation for cirrhosis or liver resection for HCC at our institution between 2003 and 2014...
September 29, 2016: BMC Cancer
Teerapat Ungtrakul, Chulabhorn Mahidol, Pattra Chun-On, Charlie Laohapand, Surachate Siripongsakun, Akeanong Worakitsitisatorn, Sirachat Vidhayakorn, Wariya Boonchuay, Jiraporn Dechma, Gaidganok Sornsamdang, Kamonwan Soonklang, Tassanee Sriprayoon, Tawesak Tanwandee, Chirayu U Auewarakul
AIM: To determine the role of screening and surveillance of hepatocellular carcinoma (HCC) in treatment-naïve chronic hepatitis B (CHB) patients. METHODS: We recruited 2293 CHB patients (both males and females; aged 20-65 years). All patients were screened and underwent surveillance using abdominal ultrasonography (AUS) and serum alpha-fetoprotein (AFP) assay every 6 mo. The diagnosis, staging and treatment of HCC followed the American Association for the Study of Liver Diseases practice guidelines and the Barcelona Clinic Liver Cancer guidelines...
September 14, 2016: World Journal of Gastroenterology: WJG
Daniel M Forton
PURPOSE OF REVIEW: Directly acting antiviral drug (DAA) treatments represent a major advance in hepatitis C management, achieving virological cures in excess of 90%. When treatment failure occurs, it is mostly due to relapse with the emergence of resistance-associated variants. RECENT FINDINGS: Data from in-vitro studies and clinical trials have enabled characterization of the amino acid substitutions in antiviral drug targets that confer reduced susceptibility to DAAs...
September 26, 2016: Current Opinion in Infectious Diseases
Aparna Goel, Mollie Biewald, Shirish Huprikar, Thomas Schiano, Gene Y Im
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis associated with high mortality. More than 20% of patients with SBP do not respond to initial antibiotics. Guidelines differ in recommendations to repeat paracentesis (retap) to confirm antibiotic efficacy. We aim to evaluate the effect of retap-guided management of SBP on antibiotic escalation and 30-day transplant-free survival. MATERIALS AND METHODS: Retrospective cohort study of cirrhotic patients with SBP admitted to a single transplant center from 2010 to 2014...
September 22, 2016: Journal of Clinical Gastroenterology
Rohan M Modi, Nishi Patel, Sherif N Metwally, Khalid Mumtaz
Hepatorenal syndrome (HRS) plays an important role in patients with liver cirrhosis on the wait list for liver transplantation (LT). The 1 and 5-year probability of developing HRS in cirrhotic with ascites is 20% and 40%, respectively. In this article, we reviewed current concepts in HRS pathophysiology, guidelines for HRS diagnosis, effective treatment options presently available, and controversies surrounding liver alone vs simultaneous liver kidney transplant (SLKT) in transplant candidates. Many treatment options including albumin, vasoconstrictors, renal replacement therapy, and eventual LT have remained a mainstay in the treatment of HRS...
August 28, 2016: World Journal of Hepatology
Pongphob Intaraprasong, Sith Siramolpiwat, Ratha-Korn Vilaichone
Hepatocellular carcinoma (HCC) is the most frequent type of malignant liver tumor and a high impact health problem worldwide. The prevalence of HCC is particularly high in many Asian and African countries. Some HCC patients have no symptoms prior to diagnosis and many of them therefore present at late stage and have a grave prognosis. The well-established causes of HCC are chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection or alcoholic cirrhosis and nonalcoholic steatohepatitis. The Barcelona Clinic Liver Cancer (BCLC) Staging System remains the most widely used for HCC management guidelines...
2016: Asian Pacific Journal of Cancer Prevention: APJCP
R Flisiak, E Janczewska, M Wawrzynowicz-Syczewska, J Jaroszewicz, D Zarębska-Michaluk, K Nazzal, B Bolewska, J Bialkowska, H Berak, K Fleischer-Stępniewska, K Tomasiewicz, K Karwowska, K Rostkowska, A Piekarska, O Tronina, G Madej, A Garlicki, M Lucejko, A Pisula, E Karpińska, W Kryczka, A Wiercińska-Drapało, I Mozer-Lisewska, M Jabłkowski, A Horban, B Knysz, M Tudrujek, W Halota, K Simon
BACKGROUND: Virologic and safety outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin (OBV/PTV/r ± DSV ± RBV) therapy have shown high sustained virologic response (SVR) rates and good tolerability in most patient populations in pre-registration studies. AIM: To confirm these clinical trial findings in the treatment of genotype 1 and 4 hepatitis C under real-world conditions. METHODS: Patients enrolled for treatment with OBV/PTV/r ± DSV ± RBV based on therapeutic guidelines were included, and the regimen was administered according to product characteristics...
November 2016: Alimentary Pharmacology & Therapeutics
Mishal Mendiratta-Lala, Hakmin Park, Nik Kolicaj, Vivek Mendiratta, Deep Bassi
PURPOSE: Liver transplant guidelines for diagnosing hepatocellular carcinoma (HCC) do not mandate pathologic confirmation; instead, 'classic' imaging features alone are deemed satisfactory. Intrahepatic peripheral mass forming cholangiocarcinoma (IHPMCC) is a relative contraindication for transplantation due to high rate of recurrence and poor prognosis. This study examines the imaging findings of IHPMCC, to aid in the identification and differentiation from potentially confounding cases of HCC...
September 3, 2016: Abdominal Radiology
Christina Wang, Vincent Chen, Vinh Vu, An Le, Linda Nguyen, Changqing Zhao, Carrie R Wong, Nghia Nguyen, Jiayi Li, Jian Zhang, Huy Trinh, Mindie H Nguyen
Our goal was to examine rates and predictors for hepatocellular carcinoma (HCC) surveillance adherence and persistency, since studies of such adherence and persistency in patients with chronic hepatitis (CHB) are currently limited.Consecutive CHB patients (N = 1329) monitored for ≥1 year at 4 US clinics from January 1996 to July 2013 were retrospectively studied. Surveillance adherence was evaluated based on the American Association for the Study of Liver Diseases guidelines. Kaplan-Meier method was used to analyze surveillance persistency of 510 patients who had initially fair adherence (having at least annual surveillance imaging with further follow-up)...
August 2016: Medicine (Baltimore)
Rana Khazar Al-Zoubi, Mouhanna Abu Ghanimeh, Ashraf Gohar, Gary A Salzman, Osama Yousef
Hepatic Hydrothorax (HH) is defined as a pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. It is an uncommon complication of cirrhosis, most frequently seen in association with decompensated liver disease. The development of HH remains incompletely understood and involves a complex pathophysiological process with the most acceptable explanation being the passage of the ascetic fluid through small diaphragmatic defects. Given the limited capacity of the pleural space, even the modest pleural effusion can result in significant respiratory symptoms...
August 31, 2016: Hospital Practice (Minneapolis)
M B Hilscher, L J Odell, L J Myhre, L Prokop, J Talwalkar
WHAT IS KNOWN AND OBJECTIVE: The presence of cirrhosis has a multifaceted impact on hepatic drug metabolism. An area of concern and uncertainty in the care of patients with cirrhosis is the safe use of both prescription and over-the-counter medications. COMMENT: Retrospective studies indicate a high incidence of adverse drug reactions (ADRs) among patients with cirrhosis related to use of certain medication classes including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and non-steroidal anti-inflammatory drugs...
August 31, 2016: Journal of Clinical Pharmacy and Therapeutics
Massimo Colombo, Angelo Sangiovanni
Hepatocellular carcinoma (HCC) is the third leading cause of cancer death and the first in patients with compensated cirrhosis. Chronic infection with hepatitis B and C, alcohol, smoking, exposure to aflatoxin and metabolic syndrome, associated with diabetes and obesity are the main etiological factors. Regardless of etiology, patients with cirrhosis stand as the category at higher risk of developing HCC, and indeed are the target of surveillance programs aimed to the early diagnosis of HCC, the only chance to reduce HCC-related mortality...
July 2016: Recenti Progressi in Medicina
Davide Festi, Giovanni Marasco, Federico Ravaioli, Antonio Colecchia
Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and it can manifest with a broad spectrum of neuropsychiatric abnormalities of varying severity, acuity and time course with important clinical implications. According to recent guidelines, HE has been classified into different types, depending on the severity of hepatic dysfunction, the presence of porto-systemic shunts and the number of previous episodes or persistent manifestations. From a clinical point of view, HE can be recognized as unimpaired, covert (that deals with minimal and grade 1 according to the grading of mental state), and overt (that is categorized from grade 2 to grade 4)...
July 2016: Recenti Progressi in Medicina
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