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Nina Kimer, Julie Steen Pedersen, Troels Malte Busk, Lise Lotte Gluud, Lise Hobolth, Aleksander Krag, Søren Møller, Flemming Bendtsen
BACKGROUND AND RATIONALE: Decompensated cirrhosis is characterized by disturbed systemic and splanchnic hemodynamics. Bacterial translocation from the gut is considered the key driver in this process. Intestinal decontamination with rifaximin may improve hemodynamics. This double-blind, randomized, controlled trial investigates the effects of rifaximin on hemodynamics, renal function and vasoactive hormones. METHODS: We randomized 54 stable out-patients with cirrhosis and ascites to rifaximin 550 mg BD (n=36) or placebo BD (n=18)...
October 24, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Matthias Buechter, Alisan Kahraman, Paul Manka, Guido Gerken, Christoph Jochum, Ali Canbay, Alexander Dechêne
BACKGROUND/AIMS: Portal hypertension (PH) is a common complication of chronic liver disease and results in esophageal and gastric variceal bleeding, which is associated with a high mortality rate. Measurement of the hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing PH and estimating the risk of varices and bleeding. In contrast, upper gastrointestinal (GI) endoscopy (UGE) can reliably demonstrate the presence of varices and bleeding. Both measures are invasive, and HVPG is mainly restricted to tertiary centers...
October 19, 2016: Digestion
Vijendra Kirnake, Anil Arora, Varun Gupta, Praveen Sharma, Vikas Singla, Naresh Bansal, Mohan Goyal, Romesh Chawlani, Ashish Kumar
BACKGROUND: Non-selective beta-blockers (NSBBs), e.g. propranolol, are recommended for prophylaxis of variceal bleeding in cirrhosis. Carvedilol, a newer NSBB with additional anti-α1-adrenergic activity, is superior to propranolol in reducing portal pressure. Repeated HVPG measurements are required to identify responders to NSBB. We aimed to determine whether a single-time HVPG measurement, using acute-hemodynamic-response-testing, is sufficient to predict long-term response to carvedilol, and whether these responders have better clinical outcome...
September 2016: Journal of Clinical and Experimental Hepatology
Sudhakar Kundapur Venkatesh, Rohit Loomba
No abstract text is available yet for this article.
September 20, 2016: Journal of Hepatology
Ki Tae Suk, Eun Jin Kim, Dong Joon Kim, Hyo Sun Kim, Chang Seok Bang, Tae Young Park, Gwang Ho Baik, Sung Eun Kim, Ji Won Park, Sang Hoon Park, Myung Seok Lee, Hyoung Su Kim, Myoung Kuk Jang, Seung Ha Park, Eunhee Choi, Chang H Kim, Hotaik Sung, Choong Kee Park
BACKGROUND & GOALS: Early identification of hepatocellular carcinoma (HCC) is associated with improved survival for patients with chronic liver disease (CLD). We evaluated the prognostic significance of hemodynamic stage (HS) and clinical stage (CS) in predicting HCC in CLD patients. METHODS: Between January 2006 and May 2014, 801 patients with CLD who underwent hepatic venous pressure gradient (HVPG) measurement were prospectively enrolled. HS was classified by HVPG (mm Hg) as follows: HS-1 (HVPG≤6), HS-2 (6<HVPG≤10), HS-3 (10<HVPG≤12), HS-4 (12<HVPG≤20), and HS-5 (20<HVPG)...
September 22, 2016: Journal of Clinical Gastroenterology
Juan G Abraldes, Christophe Bureau, Horia Stefanescu, Salvador Augustin, Michael Ney, Hélène Blasco, Bogdan Procopet, Jaime Bosch, Joan Genesca, Annalisa Berzigotti
In patients with compensated advanced chronic liver disease (cACLD) the presence of clinically significant portal hypertension (CSPH) and varices needing treatment (VNT) bears prognostic and therapeutic implications. Our aim was to develop non-invasive tests based risk prediction models to provide a point-of-care risk assessment of cACLD patients. We analyzed 518 patients with cACLD from 5 centers in Europe/Canada with paired non-invasive tests (liver stiffness by transient elastography(LSM), platelet count and spleen diameter with calculation of LSPS score and platelet-spleen ratio (PSR)) and endoscopy/HVPG measurement...
September 17, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Vipin Gupta, Ramakant Rawat, Shalimar, Anoop Saraya
BACKGROUND AND AIMS: Endoscopic variceal ligation (EVL) plus beta blocker is the mainstay treatment after index bleed to prevent rebleed. Primary objective of this study was to compare EVL plus propranolol versus EVL plus carvedilol on reduction of HVPG after 1 month of therapy. METHODS: Patients of cirrhosis presenting with index esophageal variceal bleed received standard treatment (Somatostatin therapy f/b EVL) following which HVPG was measured and patients were randomized to propranolol or carvedilol group if HVPG was >12 mmHg...
September 13, 2016: Hepatology International
Sang G Kim, Tae Y Kim, Joo H Sohn, Soon H Um, Yeon S Seo, Soon K Baik, Moon Y Kim, Jae Y Jang, Soung W Jeong, Bora Lee, Young S Kim, Ki T Suk, Dong J Kim
OBJECTIVES: Propranolol has been used as prophylaxis for variceal bleeding in patients with cirrhosis. More recent data suggest that carvedilol may be more effective for reducing the hepatic venous pressure gradient (HVPG) than propranolol. The primary aim of this study was to evaluate the hemodynamic response to carvedilol compared with propranolol. METHODS: A total of 110 patients with a baseline HVPG value >12 mm Hg were allocated randomly to receive either carvedilol or propranolol...
August 30, 2016: American Journal of Gastroenterology
Christian Jansen, Christopher Bogs, Wim Verlinden, Maja Thiele, Philipp Möller, Jan Görtzen, Jennifer Lehmann, Thomas Vanwolleghem, Luisa Vonghia, Michael Praktiknjo, Johannes Chang, Aleksander Krag, Christian P Strassburg, Sven Francque, Jonel Trebicka
BACKGROUND AND AIMS: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of liver cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis of CSPH. We recently showed the algorithm to rule-out CSPH by using sequential liver- (L-SWE) and spleen-Shear-wave elastography (S-SWE). This study investigated the diagnostic value of S-SWE for diagnosis of CSPH...
August 29, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Xiaolong Qi, Xin Zhang, Zhijia Li, Jialiang Hui, Yi Xiang, Jinjun Chen, Jianbo Zhao, Jing Li, Fu-Zhen Qi, Yong Xu
Hepatic venous pressure gradient (HVPG) measurement provides independent prognostic value in patients with cirrhosis, and the prognostic and predictive role of HVPG in hepatocellular carcinoma (HCC) also has been explored. The management of HCC is limited to the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) guidelines that consider that HVPG≥10 mmHg to be a contraindication for hepatic resection (HR), otherwise other treatment modalities are recommended...
August 23, 2016: Oncotarget
Chang Seok Bang, Hyo Sun Kim, Ki Tae Suk, Sung Eun Kim, Ji Won Park, Seung Ha Park, Hyoung Su Kim, Myoung Kuk Jang, Sang Hoon Park, Myung Seok Lee, Choong Kee Park, Dong Joon Kim
BACKGROUND: Portal hypertensive gastropathy (PHG) is a frequently overlooked complication of liver cirrhosis (LC). The clinical implications of PHG as a prognostic factor of LC or a predictive factor for the development of hepatocellular carcinoma (HCC) have not been established. The aim of this study was to assess the clinical significance of PHG in patients with LC. METHODS: Patients with LC were prospectively enrolled and followed in a single tertiary hospital in the Republic of Korea...
2016: BMC Gastroenterology
Andrej Hari, Hari Kumar Nair, Andrea De Gottardi, Iris Baumgartner, Jean-François Dufour, Annalisa Berzigotti
BACKGROUND & AIMS: Hepatic venous pressure gradient (HVPG) and transjugular liver biopsy (TJLB) are increasingly used in the management of patients with liver disease. We aimed to describe the safety profile of these procedures, providing data on the intra- and peri-procedure complications, radiation exposure, and amount of iodinated contrast material used. METHODS: In 106 consecutive patients undergoing HVPG and TJLB data on fluoroscopy time (FT), absorbed radiation dose, equivalent effective dose (mSv), and volume of iodinated contrast material (ICM) were prospectively collected and reviewed, together with clinical and laboratory data...
August 6, 2016: Liver International: Official Journal of the International Association for the Study of the Liver
Naaventhan Palaniyappan, Eleanor Cox, Christopher Bradley, Robert Scott, Andrew Austin, Richard O'Neill, Greg Ramjas, Simon Travis, Hilary White, Rajeev Singh, Peter Thurley, Indra Neil Guha, Susan Francis, Guruprasad Padur Aithal
BACKGROUND & AIMS: Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure. METHODS: 30 patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase-contrast MRI) were assessed...
July 27, 2016: Journal of Hepatology
Y Zhuang, H Ding, H Han, F Mao, J J Luo, S Y Chen, W P Wang
OBJECTIVE: To investigate the correlation between contrast-enhanced ultrasound parameters and hepatic venous pressure gradient (HVPG), and to develop a new noninvasive method for the evaluation of portal hypertension in patients with decompensated liver cirrhosis. METHODS: One-hundred patients with decompensated liver cirrhosis were examined by contrast-enhanced ultrasound, and the dynamic images were collected for offline analysis. The contrast arrival time was obtained in the hepatic artery (HA), portal vein (PV), and hepatic vein (HV), and HA-HV transit time (HA-HVTT) and PV-HV transit time (PV-HVTT) were calculated...
April 2016: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Preete Kapisha Hurry, Jørgen Hjelm Poulsen, Flemming Bendtsen, Søren Møller
BACKGROUND: Early detection of renal dysfunction in cirrhosis is important and several renal biomarkers have been put forward. NGAL and Cystatin C are markers of renal dysfunction, but relations to splanchnic and systemic hemodynamics and kinetics are sparsely studied in cirrhosis. AIMS: In patients with cirrhosis and portal hypertension we studied plasma levels and renal, hepatic and peripheral extraction of NGAL and Cystatin C and relations to patients characteristics, liver dysfunction, and hemodynamics...
July 20, 2016: Journal of Gastroenterology and Hepatology
Ricardo U Macías-Rodríguez, Hermes Ilarraza-Lomelí, Astrid Ruiz-Margáin, Sergio Ponce-de-León-Rosales, Florencia Vargas-Vorácková, Octavio García-Flores, Aldo Torre, Andrés Duarte-Rojo
OBJECTIVES: Exercise has been scarcely studied in patients with cirrhosis, and prior evidence showed hepatic venous pressure gradient (HVPG) to be increased in response to exercise. The aim of this study was to investigate the effects of a supervised physical exercise program (PEP) in patients with cirrhosis. METHODS: In an open-label, pilot clinical trial, patients with cirrhosis were randomized to PEP (cycloergometry/kinesiotherapy plus nutritional therapy, n=14) or control (nutritional therapy, n=15); for 14 weeks...
2016: Clinical and Translational Gastroenterology
Mingyan Zhang, Guangchuan Wang, Lianhui Zhao, Zhe Wu, Wenxing Zhang, Chunqing Zhang
OBJECTIVE: The hepatic venous pressure gradient (HVPG) could be used to stratify patients in different risk groups. No studies have reported the role of transjugular intrahepatic portosystemic shunt (TIPS) placement in a subgroup of patients with a high HVPG (≥20 mmHg) for secondary prophylaxis of variceal bleeding. This study was designed to evaluate the benefit of TIPS in cirrhotic patients with a high HVPG (≥20 mmHg) for rebleeding and survival. MATERIAL AND METHODS: We included 46 cirrhotic patients with a history of variceal bleeding and a high HVPG (≥20 mmHg) admitted to our hospital between January 2013 and June 2014 (TIPS group)...
July 5, 2016: Scandinavian Journal of Gastroenterology
Bin Sun, De-Run Kong, Su-Wen Li, Dong-Feng Yu, Ging-Jing Wang, Fang-Fang Yu, Qiong Wu, Jian-Ming Xu
In this study, the authors have developed endoscopic fibre-optic pressure sensor to detect variceal pressure and presented the validation of in vivo and in vitro studies, because the HVPG requires catheterization of hepatic veins, which is invasive and inconvenient. Compared with HVPG, it is better to measure directly the variceal pressure without puncturing the varices in a noninvasive way.
2016: BioMed Research International
Ankit Bhardwaj, Chandan Kumar Kedarisetty, Chitranshu Vashishtha, Ajeet Singh Bhadoria, Ankur Jindal, Guresh Kumar, Ashok Choudhary, S M Shasthry, Rakhi Maiwall, Manoj Kumar, Vikram Bhatia, Shiv Kumar Sarin
BACKGROUND AND AIMS: Carvedilol is effective in the primary prophylaxis for large oesophageal varices. We investigated its use in preventing progression of small to large oesophageal varices. METHODS: Consecutive cirrhotics with small oesophageal varices were prospectively randomised to either carvedilol (n=70) or placebo (n=70) and followed up for a minimum of 24 months. Endoscopy was done at baseline and six monthly intervals. Hepatic vein pressure gradient (HVPG) was measured at baseline and at 12 months...
June 13, 2016: Gut
Ai Nakagawa, Masanori Atsukawa, Akihito Tsubota, Chisa Kondo, Tomomi Okubo, Taeang Arai, Norio Itokawa, Yoshiyuki Narahara, Katsuhiko Iwakiri
AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention. METHODS: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization...
June 7, 2016: World Journal of Gastroenterology: WJG
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