Current controversies in cholangiocarcinoma.

Cholangiocarcinoma represents 10% of primary liver malignancies and accounts for less than 3% of all gastrointestinal malignant tumors, with an enormous geographical variation. This neoplasia can arise from the biliary tract epithelium or hepatic progenitor cells. Depending on the anatomic localization, it is classified into three subtypes: intrahepatic, perihilar and distal. This fact is one of the main difficulties, because there are many studies that indistinctly include the results in the management of these different types of cholangiocarcinoma, without differentiating its location and even including gallbladder cancer. There are many controversial points in epidemiology, liver transplantation as a treatment, limitations of different results by group and type of treatment, histological testing and chemotherapy. This is a narrative review about topics in cholangiocarcinoma. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.

Hepatocarcinoma (CHC) y trasplante hepático / Hepatocellular carcinoma (HCC) and liver transplantation

El trasplante hepático constituye hoy en día la mejor modalidad terapéutica para el hepatocarcinoma, ya que permite no solamente erradicar la lesión tumoral, sino, también, el hígado cirrótico con potencial de nuevos tumores y, de esta forma, mejorar la sobrevida y obtener mejores posibilidades de curación a corto y largo plazos. En esta revisión se pretende dar una visión actualizada del manejo del hepatocarcinoma en el paciente cirrótico, desde que se identifica la lesión inicial, los criterios de enlistamiento y exclusión, el seguimiento y alternativas terapéuticas en la lista de espera, la importancia del estudio del explante en el manejo futuro y, finalmente, el pronóstico a largo plazo y las terapias coadyuvantes en casos de recurrencia postrasplante.

Today liver transplantation has become the best therapeutic modality for HCC because it allows not only eradication of the tumor, but also removes cirrhotic liver with its potential for new tumors. In this way liver transplantation improves survival and chances of a cure in both the short and long term. This review aims to provide an update on management of hepatocellular carcinoma in cirrhotic patients from initial identification of the lesion, through inclusion and exclusion criteria, and including monitoring and therapeutic alternatives for patients on the waiting list for donor organs. It includes an overview of the importance of studying the explant for future management as well as long-term prognosis and adjunct therapies in cases of post-transplant recurrence.

Portal hypertensive biliopathy: A single center experience and literature review.

Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging modalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.

Hepatitis E: emerge una nueva zoonosis / Hepatitis E: a new zoonosis emerges

El virus de la hepatitis E (VEH) que pertenece a la familia Hepesviridae, género Hepesvirus. (3), completa el grupo de los cinco virus hepatotrofos que más frecuentemente infectan al ser humano, Se estima que en la actualidad es la causa más frecuente de hepatitis aguda e ictericia en el mundo (1). El VHE fue descrito por primera vez en 1970 por Khuroo y colegas en Kashimir, India y por Purcell y cols US, en estudios retrospectivos de brotes epidémicos de hepatitis viral ocurridos en 1955-1956 en New Delhi, India, y brotes históricos con similares características tan tempranos como 1794 (2). El VEH es un virus pequeño, 27-34 nm, de forma icosahédrica y que contiene un ARN de una sola cadena que contiene dos pequeñas regiones no transcritas en ambos extremos del genoma, y tres regiones no transcritas (ORF's) parcialmente sobrepuestas que codifican las proteínas de la cápside y de una pequeña proteína esencial para el egreso de la célula (3).

Enfermedad hepática por infiltración grasa no alcohólica: la nueva pandemia del milenio: [revisión] / Non alcoholic fatty liver disease: the new millennium pandemia: [review]

La enfermedad hepática por infiltración grasa no alcohólica (NAFLD) es la más frecuente en las sociedades desarrolladas, comprometiendo 2-8% de la población general, y en las nuestras está en camino de serlo. Es generalmente asintomática o con síntomas y signos inespecíficos como fatiga, hepatomegalia y dolor, o sensación de peso en el hígado. El diagnóstico se sospecha en presencia de pruebas hepáticas o imágenes diagnósticas anormales. La biopsia hepática es el estándar diagnóstico. Existe una clara relación con la obesidad, la diabetes tipo 2, el síndrome metabólico y la resistencia a la insulina. Aproximadamente, 20-25% de los pacientes progresan a cirrosis y sus complicaciones, incluyendo el carcinoma hepatocelular y la necesidad de un trasplante hepático. La corrección de la resistencia a la insulina con modificaciones dietéticas y el aumento de la actividad física es generalmente beneficiosa. La efectividad de los múltiples medicamentos disponibles está por demostrarse.

Non-alcoholic liver disease (NAFLD) is the most common liver disease in affluent societies, affecting 2-8% of the general population, and it will be soon in our societies. It is generally asymptomatic or with a no specific picture of fatigue, hepatic pain or discomfort and hepatomegaly. It is suspected in cases with aminotransferase or imaging abnormalities. Liver biopsy is considered the gold standard for diagnosis. There is a close pathogenic relationship with obesity, type 2 diabetes, hyperlipidemia, metabolic syndrome and insulin resistance. Approximately 20-25% of the cases progress into cirrhosis with all its complications including hepatocellular carcinoma and the need for liver transplantation. Correction of insulin resistance with dietary measures and physical activity is generally beneficial. The efficacy of the multiple medications available remains to be demonstrated.

Drug-induced liver injury: hepatotoxicity of quetiapine revisited.

Drug hepatotoxicity is the most common cause of fulminant hepatic failure in the USA. We describe a rare case of a patient who developed an acute liver injury after initiation of therapy with quetiapine, but after conservative management and a trial of steroids, has fully recovered. This is the second reported case of quetiapine-induced liver injury in the published literature.

Organ allocation: model for end-stage liver disease, Child-Turcotte-Pugh, Mayo risk score, or something else.

The discovery of a single test of liver function has been a goal of hepatologists for many years. The great complexity of the liver and its many diverse functions, however, has prevented such an accomplishment. An analogy can be made with the way one currently uses liver tests where several individual tests are combined into a profile. This article presents evidence that confirms the same concept: Only by combining several clinical and laboratory measures can we predict the prognosis of liver disease patients. End-stage liver disease and pediatric end-stage liver disease models are valuable additions to the prognostic armamentarium; however, these models are not perfect and some important indications for liver transplant today cannot be included because their main issue is not disease severity.