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1.
World J Gastroenterol ; 30(23): 2954-2958, 2024 Jun 21.
Article de Anglais | MEDLINE | ID: mdl-38946869

RÉSUMÉ

The Baveno VII criteria redefine the management of decompensated liver cirrhosis, introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline. Central to this concept is addressing the underlying cause of cirrhosis through tailored therapies, including antivirals and lifestyle modifications. Studies on alcohol, hepatitis C virus, and hepatitis B virus-related cirrhosis demonstrate the efficacy of these interventions in improving liver function and patient outcomes. Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a promising intervention, effectively resolving complications of portal hypertension and facilitating recompensation. However, optimal timing and patient selection for TIPS remain unresolved. Despite challenges, TIPS offers renewed hope for hepatic recompensation, marking a significant advancement in cirrhosis management. Further research is needed to refine its implementation and maximize its benefits. In conclusion, TIPS stands as a promising avenue for improving hepatic function and patient outcomes in decompensated liver cirrhosis within the framework of the Baveno VII criteria.


Sujet(s)
Hypertension portale , Cirrhose du foie , Sélection de patients , Anastomose portosystémique intrahépatique par voie transjugulaire , Humains , Cirrhose du foie/virologie , Cirrhose du foie/diagnostic , Cirrhose du foie/complications , Cirrhose du foie/thérapie , Anastomose portosystémique intrahépatique par voie transjugulaire/méthodes , Hypertension portale/étiologie , Hypertension portale/diagnostic , Hypertension portale/thérapie , Résultat thérapeutique , Antiviraux/usage thérapeutique , Foie/chirurgie
2.
Rev Gastroenterol Peru ; 44(2): 145-149, 2024.
Article de Espagnol | MEDLINE | ID: mdl-39019808

RÉSUMÉ

Portal hypertension (PHT) is defined as an increase in pressure at the level of the portal vein above 5 mmHg, the most common cause being liver cirrhosis. Among the presinusoidal intrahepatic causes of PHT with portal venular involvement, what was traditionally known as idiopathic non-cirrhotic portal hypertension (NCIH) is described, with the requirements of excluding those patients who did not present PHT, as well as those with the presence of liver cirrhosis and thrombosis. portal venous vein (PVT). Currently, the diagnostic criteria for this entity have been reconsidered, and its name, being known as porto-sinusoidal vascular disease (PSVD), also does not exclude patients with PHT or the presence of underlying liver disease. Liver biopsy continues to be the gold standard for diagnosis. The clinical manifestations are derived from PHT and the management is similar to the complications that occur in patients with liver cirrhosis. The case of a male patient is presented who presents with symptoms of digestive bleeding, with findings of esophageal varices in upper endoscopy in addition to a study of viral, autoimmune liver disease and negative deposits, with a conclusive liver biopsy of porto-sinusoidal vascular disease.


Sujet(s)
Hémorragie gastro-intestinale , Hypertension portale , Humains , Mâle , Hémorragie gastro-intestinale/étiologie , Hémorragie gastro-intestinale/diagnostic , Hypertension portale/complications , Hypertension portale/étiologie , Hypertension portale/diagnostic , Veine porte , Adulte d'âge moyen , Maladie veno-occlusive hépatique/diagnostic , Maladie veno-occlusive hépatique/complications
3.
Clin Liver Dis ; 28(3): 383-400, 2024 Aug.
Article de Anglais | MEDLINE | ID: mdl-38945633

RÉSUMÉ

Measurement of hepatic venous pressure gradient (HVPG) effectively mirrors the severity of portal hypertension (PH) and offers valuable insights into prognosis of liver disease, including the risk of decompensation and mortality. Additionally, HVPG offers crucial information about treatment response to nonselective beta-blockers and other medications, with its utility demonstrated in clinical trials in patients with PH. Despite the widespread dissemination and validation of noninvasive tests, HVPG still holds a significant role in hepatology. Physicians treating patients with liver diseases should comprehend the HVPG measurement procedure, its applications, and how to interpret the results and potential pitfalls.


Sujet(s)
Hypertension portale , Pression portale , Humains , Hypertension portale/physiopathologie , Hypertension portale/diagnostic , Veines hépatiques/physiopathologie , Pronostic , Indice de gravité de la maladie
4.
Clin Liver Dis ; 28(3): 455-466, 2024 Aug.
Article de Anglais | MEDLINE | ID: mdl-38945637

RÉSUMÉ

Porto-sinusoidal vascular disease (PSVD) is the medical diagnosis for a patient who has portal hypertension in the absence of cirrhosis on liver biopsy. There are several specific histologic findings for PSVD, including obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Epidemiologic reports vary widely among regions; PSVD comprises less than 10% of causes of portal hypertension in Western countries but incidence has been found to be as high as 48% in India. There is an expansive list of etiologies that have been reported to cause PSVD.


Sujet(s)
Hypertension portale , Humains , Hypertension portale/étiologie , Hypertension portale/diagnostic , Hypertension portale/complications , Hypertension portale/épidémiologie , Maladie veno-occlusive hépatique/étiologie , Maladie veno-occlusive hépatique/diagnostic , Veine porte/anatomopathologie
5.
Clin Liver Dis ; 28(3): 401-415, 2024 Aug.
Article de Anglais | MEDLINE | ID: mdl-38945634

RÉSUMÉ

The progressive use of noninvasive tests (NITs) has changed the way hepatologists diagnose and manage patients with chronic liver disease, mainly because of their easiness to use and the ability to be repeated during follow-up. Liver stiffness measurement is the NIT with more scientific evidence. NITs have demonstrated to be useful to detect not only liver fibrosis but also the presence of clinically significant portal hypertension. Moreover, current evidence supports they can also be useful to evaluate the prognosis of patients with chronic liver disease.


Sujet(s)
Imagerie d'élasticité tissulaire , Hypertension portale , Cirrhose du foie , Humains , Hypertension portale/diagnostic , Hypertension portale/étiologie , Hypertension portale/physiopathologie , Cirrhose du foie/diagnostic , Cirrhose du foie/complications , Cirrhose du foie/physiopathologie , Foie/imagerie diagnostique , Foie/anatomopathologie , Foie/physiopathologie , Pronostic , Varices oesophagiennes et gastriques/diagnostic , Varices oesophagiennes et gastriques/étiologie
6.
Sci Rep ; 14(1): 13674, 2024 06 13.
Article de Anglais | MEDLINE | ID: mdl-38871788

RÉSUMÉ

Managing complications of liver cirrhosis such as varices needing treatment (VNT) and clinically significant portal hypertension (CSPH) demands precise and non-invasive diagnostic methods. This study assesses the efficacy of spleen stiffness measurement (SSM) using a 100-Hz probe for predicting VNT and CSPH, aiming to refine diagnostic thresholds. A retrospective analysis was conducted on 257 cirrhotic patients, comparing the diagnostic performance of SSM against traditional criteria, including Baveno VII, for predicting VNT and CSPH. The DeLong test was used for statistical comparisons among predictive models. The success rate of SSM@100 Hz was 94.60%, and factors related to SSM failure were high body mass index and small spleen volume or length. In our cohort, the identified SSM cut-off of 38.9 kPa, which achieved a sensitivity of 92% and a negative predictive value (NPV) of 98% for detecting VNT, is clinically nearly identical to the established Baveno threshold of 40 kPa. The predictive capability of the SSM-based model for VNT was superior to the LSM ± PLT model (p = 0.017). For CSPH prediction, the SSM model notably outperformed existing non-invasive tests (NITs), with an AUC improvement and significant correlations with HVPG measurements (obtained from 49 patients), highlighting a correlation coefficient of 0.486 (p < 0.001) between SSM and HVPG. Therefore, incorporating SSM into clinical practice significantly enhances the prediction accuracy for both VNT and CSPH in cirrhosis patients, mainly due to the high correlation between SSM and HVPG. SSM@100 Hz can offer valuable clinical assistance in avoiding unnecessary endoscopy in these patients.


Sujet(s)
Imagerie d'élasticité tissulaire , Hypertension portale , Cirrhose du foie , Rate , Humains , Cirrhose du foie/complications , Cirrhose du foie/diagnostic , Mâle , Adulte d'âge moyen , Femelle , Rate/anatomopathologie , Hypertension portale/diagnostic , Hypertension portale/physiopathologie , Études rétrospectives , Sujet âgé , Imagerie d'élasticité tissulaire/méthodes , Varices oesophagiennes et gastriques/diagnostic , Varices oesophagiennes et gastriques/étiologie , Adulte
7.
Medicine (Baltimore) ; 103(23): e38424, 2024 Jun 07.
Article de Anglais | MEDLINE | ID: mdl-38847721

RÉSUMÉ

RATIONAL: Congenital hepatic fibrosis (CHF) is a rare autosomal recessive genetic disease, which is often diagnosed in children and young adults. The clinical manifestations of CHF were lack of specificity, mainly including portal hypertension related symptoms and signs, and normal or mildly abnormal liver function. When no obvious varices are indicated under endoscope, it can easily lead to misdiagnosis or missed diagnosis. We report this case in the hope of raising awareness of this disease. PATIENT CONCERNS: A 31 years old male patient with major clinical manifestations of unexplained thrombocytopenia for 5 years. DIAGNOSES: Results of ultrasound, magnetic resonance imaging (MRI) and computed tomography portal venography (CTV) showed that patient had liver cirrhosis with portal hypertension and liver biopsy revealed CHF. INTERVENTION: Patient received ursodeoxycholic acid tablets, fuzheng huayu capsule, ganshuang granule, etc for liver protection treatment. OUTCOMES: The condition of patient stabilized after symptomatic treatment. Spleen resection will be considered during follow-up. LESSONS: This case reminds us that in case of patients with negative endoscopic evaluation, ultrasonic, computed tomography (CT) and MRI examination should be performed at the same time to determine whether patients have portal hypertension. When patients with normal or mildly abnormal liver function had unexplained liver cirrhosis complicated with portal hypertension, the possibility of CHF should be considered.


Sujet(s)
Varices oesophagiennes et gastriques , Cirrhose du foie , Humains , Mâle , Varices oesophagiennes et gastriques/étiologie , Varices oesophagiennes et gastriques/diagnostic , Adulte , Cirrhose du foie/complications , Hypertension portale/complications , Hypertension portale/diagnostic , Maladies génétiques congénitales/complications , Maladies génétiques congénitales/diagnostic , Imagerie par résonance magnétique/méthodes , Tomodensitométrie/méthodes
8.
Expert Rev Gastroenterol Hepatol ; 18(6): 239-256, 2024 Jun.
Article de Anglais | MEDLINE | ID: mdl-38785070

RÉSUMÉ

INTRODUCTION: Classically, clinical practice guidelines and expert recommendations have focused on the management of decompensated cirrhotic patients, so we focused this review on improving care for compensated cirrhotic patients who are followed up in outpatient clinics. AREAS COVERED: We reviewed the current methods for establishing liver function, the diagnosis and management of advanced chronic liver disease and clinically significant portal hypertension as well as the prevention of its complications, with special attention to covert hepatic encephalopathy, we also paid attention to the extrahepatic complications of cirrhosis and the palliative care. All this from the perspective of evidence-based medicine and trying to empower precision medicine. The literature search was undertaken by PubMed with 'cirrhosis,' 'advanced chronic liver disease,' 'liver function,' 'portal hypertension,' 'covert hepatic encephalopathy,' 'minimal hepatic encephalopathy,' 'palliative care' as MeSH terms. EXPERT OPINION: We must offer compensated cirrhotic patients specific care and measures to prevent the progression of the disease and the appearance of its complications beyond the calculation of liver function and imaging screening for hepatocellular carcinoma that we perform every six months. Entities that have typically received little attention, such as covert hepatic encephalopathy, extrahepatic complications and symptoms of cirrhosis, and palliative care, must come to the spotlight.


Sujet(s)
Encéphalopathie hépatique , Cirrhose du foie , Soins palliatifs , Humains , Cirrhose du foie/complications , Cirrhose du foie/thérapie , Encéphalopathie hépatique/thérapie , Encéphalopathie hépatique/étiologie , Encéphalopathie hépatique/diagnostic , Hypertension portale/thérapie , Hypertension portale/étiologie , Hypertension portale/diagnostic , Évolution de la maladie , Tests de la fonction hépatique
9.
World J Gastroenterol ; 30(16): 2285-2286, 2024 Apr 28.
Article de Anglais | MEDLINE | ID: mdl-38690019

RÉSUMÉ

This is a retrospective study focused on recompensation after transjugular intrahepatic portosystemic shunt (TIPS) procedure. The authors confirmed TIPS could be a treatment for recompensation of patients with cirrhosis according to Baveno VII. The paper identified age and post-TIPS portal pressure gradient as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS. These results need to be validated in a larger prospective cohort.


Sujet(s)
Hypertension portale , Cirrhose du foie , Pression portale , Anastomose portosystémique intrahépatique par voie transjugulaire , Anastomose portosystémique intrahépatique par voie transjugulaire/méthodes , Humains , Cirrhose du foie/chirurgie , Cirrhose du foie/complications , Études rétrospectives , Hypertension portale/chirurgie , Hypertension portale/étiologie , Hypertension portale/diagnostic , Hypertension portale/physiopathologie , Résultat thérapeutique , Adulte d'âge moyen , Femelle , Mâle , Sujet âgé , Facteurs âges , Encéphalopathie hépatique/étiologie , Encéphalopathie hépatique/chirurgie
11.
Medicina (Kaunas) ; 60(5)2024 Apr 24.
Article de Anglais | MEDLINE | ID: mdl-38792873

RÉSUMÉ

Clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease indicates an increased risk of decompensation and death. While invasive methods like hepatic venous-portal gradient measurement is considered the gold standard, non-invasive tests (NITs) have emerged as valuable tools for diagnosing and monitoring CSPH. This review comprehensively explores non-invasive diagnostic modalities for portal hypertension, focusing on NITs in the setting of hepatitis B and hepatitis C virus-related cirrhosis. Biochemical-based NITs can be represented by single serum biomarkers (e.g., platelet count) or by composite scores that combine different serum biomarkers with each other or with demographic characteristics (e.g., FIB-4). On the other hand, liver stiffness measurement and spleen stiffness measurement can be assessed using a variety of elastography techniques, and they can be used alone, in combination with, or as a second step after biochemical-based NITs. The incorporation of liver and spleen stiffness measurements, alone or combined with platelet count, into established and validated criteria, such as Baveno VI or Baveno VII criteria, provides useful tools for the prediction of CSPH and for ruling out high-risk varices, potentially avoiding invasive tests like upper endoscopy. Moreover, they have also been shown to be able to predict liver-related events (e.g., the occurrence of hepatic decompensation). When transient elastography is not available or not feasible, biochemical-based NITs (e.g., RESIST criteria, that are based on the combination of platelet count and albumin levels) are valid alternatives for predicting high-risk varices both in patients with untreated viral aetiology and after sustained virological response. Ongoing research should explore novel biomarkers and novel elastography techniques, but current evidence supports the utility of routine blood tests, LSM, and SSM as effective surrogates in diagnosing and staging portal hypertension and predicting patient outcomes.


Sujet(s)
Marqueurs biologiques , Imagerie d'élasticité tissulaire , Hypertension portale , Cirrhose du foie , Humains , Hypertension portale/complications , Hypertension portale/physiopathologie , Hypertension portale/diagnostic , Hypertension portale/étiologie , Cirrhose du foie/complications , Cirrhose du foie/sang , Cirrhose du foie/diagnostic , Imagerie d'élasticité tissulaire/méthodes , Marqueurs biologiques/sang , Hépatite B/complications , Hépatite B/diagnostic , Numération des plaquettes , Hépatite C/complications , Hépatite C/diagnostic , Rate/imagerie diagnostique
12.
Aliment Pharmacol Ther ; 59(12): 1527-1538, 2024 06.
Article de Anglais | MEDLINE | ID: mdl-38629442

RÉSUMÉ

BACKGROUND: Non-cirrhotic portal hypertension (NCPH) is a spectrum of liver diseases, including porto-sinusoidal vascular disorder, with portal hypertension (PH) in the absence of cirrhosis. The natural history and diagnostic approach to NCPH are not well understood. AIM: We aimed to evaluate disease progression and outcomes in NCPH. METHODS: Patients with or at risk for NCPH were enrolled in a single centre prospective study; two groups were formed based on the presence of specific features of PH, such as varices, collaterals, portal hypertensive gastropathy or portal hypertensive bleeding. All participants underwent a baseline liver biopsy. Liver stiffness measurement (LSM), and imaging were repeated every 6-12 months. RESULTS: Fifteen patients without specific features of PH (Group I), and 35 patients with specific features (Group II) were enrolled. The median follow-up time was 50 months. Group II had higher hepatic venous pressure gradients, non-invasive measures of PH and a lower platelet count (PLT) when compared to Group I. Rates of survival and decompensation were similar in both groups. Patients with PLT ≤100 K/mcL had lower survival compared to those with PLT >100 K/mcL. Patients with LSM ≥10 kPa had lower survival and survival without decompensation when compared to patients with LSM <10 kPa. CONCLUSIONS: Patients irrespective of specific features of PH had similar survival or survival without decompensation. Patients without specific features are at risk for disease progression and should be monitored closely. Thrombocytopenia and increased LSM are associated with severe forms of liver disease, which are strongly associated with outcomes.


Sujet(s)
Évolution de la maladie , Hypertension portale , Humains , Hypertension portale/physiopathologie , Hypertension portale/complications , Hypertension portale/diagnostic , Mâle , Femelle , Études prospectives , Adulte d'âge moyen , Adulte , Numération des plaquettes , Foie/anatomopathologie , Foie/physiopathologie , Sujet âgé , Cirrhose du foie/complications , Cirrhose du foie/physiopathologie , Biopsie
13.
Trials ; 25(1): 265, 2024 Apr 16.
Article de Anglais | MEDLINE | ID: mdl-38627804

RÉSUMÉ

BACKGROUND: Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, whilst deaths related to other non-liver disease areas are declining. Portal hypertension is the primary sequelae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hepatic encephalopathy and infection, collectively termed hepatic decompensation, which leads to hospitalisation and mortality. It remains uncertain whether administering a non-selective beta-blocker (NSBB), specifically carvedilol, at an earlier stage, i.e. when oesophageal varices are small, can prevent VH and reduce all-cause decompensation (ACD). METHODS/DESIGN: The BOPPP trial is a pragmatic, multicentre, placebo-controlled, triple-blinded, randomised controlled trial (RCT) in England, Scotland, Wales and Northern Ireland. Patients aged 18 years or older with cirrhosis and small oesophageal varices that have never bled will be recruited, subject to exclusion criteria. The trial aims to enrol 740 patients across 55 hospitals in the UK. Patients are allocated randomly on a 1:1 ratio to receive either carvedilol 6.25 mg (a NSBB) or a matched placebo, once or twice daily, for 36 months, to attain adequate power to determine the effectiveness of carvedilol in preventing or reducing ACD. The primary outcome is the time to first decompensating event. It is a composite primary outcome made up of variceal haemorrhage (VH, new or worsening ascites, new or worsening hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), hepatorenal syndrome, an increase in Child-Pugh grade by 1 grade or MELD score by 5 points, and liver-related mortality. Secondary outcomes include progression to medium or large oesophageal varices, development of gastric, duodenal, or ectopic varices, participant quality of life, healthcare costs and transplant-free survival. DISCUSSION: The BOPPP trial aims to investigate the clinical and cost-effectiveness of carvedilol in patients with cirrhosis and small oesophageal varices to determine whether this non-selective beta-blocker can prevent or reduce hepatic decompensation. There is clinical equipoise on whether intervening in cirrhosis, at an earlier stage of portal hypertension, with NSBB therapy is beneficial. Should the trial yield a positive result, we anticipate that the administration and use of carvedilol will become widespread with pathways developed to standardise the administration of the medication in primary care. ETHICS AND DISSEMINATION: The trial has been approved by the National Health Service (NHS) Research Ethics Committee (REC) (reference number: 19/YH/0015). The results of the trial will be submitted for publication in a peer-reviewed scientific journal. Participants will be informed of the results via the BOPPP website ( www.boppp-trial.org ) and partners in the British Liver Trust (BLT) organisation. TRIAL REGISTRATION: EUDRACT reference number: 2018-002509-78. ISRCTN reference number: ISRCTN10324656. Registered on April 24 2019.


Sujet(s)
Varices oesophagiennes et gastriques , Encéphalopathie hépatique , Hypertension portale , Adulte , Humains , Antagonistes bêta-adrénergiques/usage thérapeutique , Ascites/traitement médicamenteux , Carvédilol/usage thérapeutique , Varices oesophagiennes et gastriques/diagnostic , Varices oesophagiennes et gastriques/étiologie , Varices oesophagiennes et gastriques/prévention et contrôle , Hémorragie gastro-intestinale/diagnostic , Hémorragie gastro-intestinale/étiologie , Hémorragie gastro-intestinale/prévention et contrôle , Encéphalopathie hépatique/diagnostic , Encéphalopathie hépatique/traitement médicamenteux , Encéphalopathie hépatique/étiologie , Hypertension portale/complications , Hypertension portale/diagnostic , Hypertension portale/traitement médicamenteux , Cirrhose du foie/complications , Cirrhose du foie/diagnostic , Cirrhose du foie/traitement médicamenteux , Études multicentriques comme sujet , Essais contrôlés randomisés comme sujet , Essais cliniques pragmatiques comme sujet
14.
World J Gastroenterol ; 30(14): 2059-2067, 2024 Apr 14.
Article de Anglais | MEDLINE | ID: mdl-38681128

RÉSUMÉ

BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established. CASE SUMMARY: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death. CONCLUSION: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.


Sujet(s)
Cholédocostomie , Hémorragie gastro-intestinale , Jéjunum , Sclérothérapie , Varices , Humains , Mâle , Varices/thérapie , Varices/chirurgie , Cholédocostomie/méthodes , Cholédocostomie/effets indésirables , Sclérothérapie/méthodes , Sclérothérapie/effets indésirables , Hémorragie gastro-intestinale/étiologie , Hémorragie gastro-intestinale/thérapie , Hémorragie gastro-intestinale/diagnostic , Jéjunum/chirurgie , Jéjunum/vascularisation , Adulte d'âge moyen , Résultat thérapeutique , Femelle , Sujet âgé , Enbucrilate/administration et posologie , Enbucrilate/effets indésirables , Hypertension portale/chirurgie , Hypertension portale/complications , Hypertension portale/diagnostic , Solutions sclérosantes/administration et posologie , Solutions sclérosantes/effets indésirables , Polidocanol/administration et posologie , Polidocanol/usage thérapeutique , Duodénopancréatectomie/effets indésirables , Duodénopancréatectomie/méthodes , Endoscopie gastrointestinale/méthodes
15.
World J Gastroenterol ; 30(13): 1859-1870, 2024 Apr 07.
Article de Anglais | MEDLINE | ID: mdl-38659484

RÉSUMÉ

BACKGROUND: Portal hypertension (PHT), primarily induced by cirrhosis, manifests severe symptoms impacting patient survival. Although transjugular intrahepatic portosystemic shunt (TIPS) is a critical intervention for managing PHT, it carries risks like hepatic encephalopathy, thus affecting patient survival prognosis. To our knowledge, existing prognostic models for post-TIPS survival in patients with PHT fail to account for the interplay among and collective impact of various prognostic factors on outcomes. Consequently, the development of an innovative modeling approach is essential to address this limitation. AIM: To develop and validate a Bayesian network (BN)-based survival prediction model for patients with cirrhosis-induced PHT having undergone TIPS. METHODS: The clinical data of 393 patients with cirrhosis-induced PHT who underwent TIPS surgery at the Second Affiliated Hospital of Chongqing Medical University between January 2015 and May 2022 were retrospectively analyzed. Variables were selected using Cox and least absolute shrinkage and selection operator regression methods, and a BN-based model was established and evaluated to predict survival in patients having undergone TIPS surgery for PHT. RESULTS: Variable selection revealed the following as key factors impacting survival: age, ascites, hypertension, indications for TIPS, postoperative portal vein pressure (post-PVP), aspartate aminotransferase, alkaline phosphatase, total bilirubin, prealbumin, the Child-Pugh grade, and the model for end-stage liver disease (MELD) score. Based on the above-mentioned variables, a BN-based 2-year survival prognostic prediction model was constructed, which identified the following factors to be directly linked to the survival time: age, ascites, indications for TIPS, concurrent hypertension, post-PVP, the Child-Pugh grade, and the MELD score. The Bayesian information criterion was 3589.04, and 10-fold cross-validation indicated an average log-likelihood loss of 5.55 with a standard deviation of 0.16. The model's accuracy, precision, recall, and F1 score were 0.90, 0.92, 0.97, and 0.95 respectively, with the area under the receiver operating characteristic curve being 0.72. CONCLUSION: This study successfully developed a BN-based survival prediction model with good predictive capabilities. It offers valuable insights for treatment strategies and prognostic evaluations in patients having undergone TIPS surgery for PHT.


Sujet(s)
Théorème de Bayes , Hypertension portale , Cirrhose du foie , Anastomose portosystémique intrahépatique par voie transjugulaire , Humains , Hypertension portale/chirurgie , Hypertension portale/mortalité , Hypertension portale/étiologie , Hypertension portale/diagnostic , Anastomose portosystémique intrahépatique par voie transjugulaire/effets indésirables , Anastomose portosystémique intrahépatique par voie transjugulaire/mortalité , Adulte d'âge moyen , Femelle , Mâle , Études rétrospectives , Pronostic , Cirrhose du foie/chirurgie , Cirrhose du foie/complications , Cirrhose du foie/mortalité , Résultat thérapeutique , Sujet âgé , Adulte , Encéphalopathie hépatique/étiologie , Encéphalopathie hépatique/chirurgie , Encéphalopathie hépatique/mortalité , Facteurs de risque , Pression portale
16.
Zhonghua Gan Zang Bing Za Zhi ; 32(3): 273-278, 2024 Mar 20.
Article de Chinois | MEDLINE | ID: mdl-38584114

RÉSUMÉ

Presently, pseudocirrhosis occurs in most patients with liver metastases from malignant tumors and can exhibit clinical manifestations related to portal hypertension, such as edema, ascites, and gastrointestinal bleeding. Imaging features include malignant tumor liver metastasis, the appearance of nodules accompanied with or without hepatic contour, segmental liver volume reduction, and caudate lobe enlargement. Histology shows the typical pathological manifestations of liver cirrhosis, such as diffuse tumor cell infiltration, fibrosis around the infiltrating lesion, hepatic sinus vascular thrombosis, nodular hyperplasia, non-accompanied bridging necrosis, bridging fibrosis, and pseudolobule formation. The possible pathogenesis of pseudocirrhosis is tumor cell infiltration and toxic reactions of tumor cells and liver cells to chemotherapy. The presence of pseudocirrhosis in patients diagnosed with malignant tumors is one of the challenges affecting their survival cycle and shortening the median survival time. The relationship between its onset, tumor type and metastasis, and the use of chemotherapy drugs is still unclear. The atypical clinical manifestations and imaging characteristics bring about great challenges for clinicians and patients. Thus, based on the existing case reports, observational studies, and meta-analysis results, this article reviews the research progress on the prevalence, etiology, pathogenesis, diagnosis, treatment, and prognosis of pseudocirrhosis.


Sujet(s)
Hypertension portale , Tumeurs du foie , Humains , Cirrhose du foie/complications , Tumeurs du foie/diagnostic , Hypertension portale/diagnostic , Pronostic
17.
Liver Transpl ; 30(7): 679-688, 2024 Jul 01.
Article de Anglais | MEDLINE | ID: mdl-38535488

RÉSUMÉ

Mean arterial blood pressure (MAP), which decreases as portal hypertension progresses, may be a modifiable risk factor among patients with cirrhosis. We included adults enrolled in the Functional Assessment in Liver Transplantation study. We completed latent class trajectory analyses to define MAP trajectories. We completed time-dependent Cox-regression analyses to test the association between outpatient MAP and 3 cirrhosis-related outcomes: (1) stage 2 acute kidney injury (AKI), defined as a ≥200% increase in serum creatinine from baseline; (2) a 5-point increase in the MELD-Na score, defined as the incidence of increase from initial MELD-Na; (3) waitlist mortality, defined as death on the waitlist. For each outcome, we defined MAP cut points by determining the maximally selected Log-rank statistic after univariable Cox-regression analyses. Among the 1786 patients included in this analysis, our latent class trajectory analyses identified 3 specific outpatient MAP trajectories: "stable-low," "stable-high," and "increasing-to-decreasing." However, >80% of patients were in a "stable-low" trajectory. We found in adjusted analyses that outpatient MAP was associated with each of our outcomes: Stage 2 AKI (adjusted hazard ratio 0.88 per 10 mm Hg increase in MAP [95% CI: 0.79-0.99]); 5-point increase in MELD-Na (adjusted hazard ratio: 0.91 [95% CI: 0.86-0.96]; waitlist mortality (adjusted hazard ratio: 0.89 [95% CI: 0.81-0.96]). For each outcome, we found that an outpatient MAP of 82 mm Hg was most associated with outcomes ( p <0.05 for all). Our study informs the association between outpatient MAP and cirrhosis-related outcomes. These findings, coupled with the identification of specific thresholds, lay the foundation for the trial of targeted outpatient MAP modulation in patients with cirrhosis.


Sujet(s)
Atteinte rénale aigüe , Pression artérielle , Cirrhose du foie , Transplantation hépatique , Listes d'attente , Humains , Atteinte rénale aigüe/étiologie , Atteinte rénale aigüe/mortalité , Atteinte rénale aigüe/diagnostic , Atteinte rénale aigüe/épidémiologie , Atteinte rénale aigüe/sang , Mâle , Femelle , Adulte d'âge moyen , Cirrhose du foie/mortalité , Cirrhose du foie/complications , Cirrhose du foie/diagnostic , Facteurs de risque , Listes d'attente/mortalité , Patients en consultation externe/statistiques et données numériques , Sujet âgé , Hypertension portale/diagnostic , Hypertension portale/mortalité , Hypertension portale/étiologie , Hypertension portale/complications , Indice de gravité de la maladie , Modèles des risques proportionnels , Créatinine/sang , Adulte , Études prospectives , Évolution de la maladie , Incidence
18.
Liver Int ; 44(6): 1298-1308, 2024 Jun.
Article de Anglais | MEDLINE | ID: mdl-38456654

RÉSUMÉ

BACKGROUND: Alcohol-related liver disease (ARLD) is often diagnosed at a late stage when mortality is unacceptably high. Earlier identification of ARLD may lead to reduced alcohol intake, participation in hepatocellular carcinoma surveillance and reduction in liver-related morbidity and mortality. People with alcohol use disorder (AUD) are at highest risk of ARLD. The aim of this systematic review was to understand the yield of proactive screening for ARLD amongst high-risk groups. METHODS: Embase, Medline, Scopus and grey literature were searched for studies describing proactive assessment for alcohol-related liver disease in people with a history of alcohol excess or diagnosed AUD. Outcomes of interest were fibrosis and cirrhosis detection rates, clinical outcomes, portal hypertension evaluation, attendance at follow-up and cost-effectiveness. RESULTS: Fifteen studies were identified for inclusion from 1115 returned by the search. Four key settings for patient engagement were identified as inpatient addiction services, outpatient addiction services, general acute hospital admissions and community outreach. Of these, acute hospital admissions were the highest yield for cirrhosis at 10.8%-29.6% and community outreach the lowest was 1.2%-2.3%. CONCLUSIONS: Targeted fibrosis assessment of high-risk populations for ARLD is feasible to conduct and identifies a proportion of patients at risk of advanced liver disease. The highest yield is amongst inpatients admitted with AUD. Prospective work is needed to establish which are the most effective and acceptable screening methods and the impact on long-term outcomes.


Sujet(s)
Maladies alcooliques du foie , Humains , Maladies alcooliques du foie/diagnostic , Maladies alcooliques du foie/épidémiologie , Alcoolisme/complications , Dépistage de masse/méthodes , Facteurs de risque , Analyse coût-bénéfice , Hypertension portale/diagnostic
19.
Curr Opin Gastroenterol ; 40(3): 148-155, 2024 05 01.
Article de Anglais | MEDLINE | ID: mdl-38547334

RÉSUMÉ

PURPOSE OF REVIEW: The result of ongoing liver injury - and disease, regardless of cause - is fibrosis, and fibrosis appears to be a critically important result of ongoing injury. Further, in a number of different liver diseases, the presence of fibrosis has prognostic value. Therefore, the assessment of fibrosis is of critical clinical importance. Given the importance of fibrosis, there has been a rapid evolution in the use of noninvasive liver tests. This review highlights a number of the core principles surrounding. RECENT FINDINGS: The use of noninvasive test has progressed rapidly over the last decade and data are rapidly accumulating. New terminology has been adapted by the American Association for the Study of Liver Disease (AASLD) for noninvasive assessment of liver disease and termed 'NILDA' (Non-Invasive Liver Disease Assessment). Blood based such as APRI and or FIB-4 and imaging tests such as liver stiffness measurement (LSM) have moderate to high degrees of accuracy for detection of advanced liver fibrosis (≥ F2) and even higher accuracy for detection of severe fibrosis (F4 or cirrhosis). NILDA are particularly effective at the ends of the liver disease spectrum. For example, a very low LSM (less than 7 kPa) essentially excludes significant fibrosis or portal hypertension, and a very high LSM (> 25 kPa) makes significant fibrosis with portal hypertension (cirrhosis) highly likely. SUMMARY: NILDA are currently front and center in terms of assessment of the severity of liver disease. In all patients with known or suspected liver disease, noninvasive blood tests, including APRI and or FIB-4, should be the initial choice to assess the severity of liver fibrosis and/or portal hypertension. In most patients, these tests should be followed with imaging evaluation. The most commonly available imaging is LSM, which appears to be more accurate in predicting fibrosis severity, and is superior to blood tests in the assessment of portal hypertension. In situations in which there is diagnostic uncertainly, liver biopsy with or without HVPG remains an important consideration.


Sujet(s)
Imagerie d'élasticité tissulaire , Hypertension portale , Humains , Imagerie d'élasticité tissulaire/méthodes , Cirrhose du foie/complications , Cirrhose du foie/diagnostic , Foie/imagerie diagnostique , Foie/anatomopathologie , Hypertension portale/diagnostic , Hypertension portale/étiologie , Pronostic , Fibrose
20.
United European Gastroenterol J ; 12(6): 667-677, 2024 Jul.
Article de Anglais | MEDLINE | ID: mdl-38363191

RÉSUMÉ

BACKGROUND: Transcutaneous point-shear wave elastography (p-SWE) performed using an acoustic radiation force impulse can be used to quantify pancreatic stiffness in chronic pancreatitis (CP). We aimed to evaluate its usefulness to diagnose and monitor CP. METHODS: 175 participants were included in this prospective study including patients with CP (n = 65), liver cirrhosis (LC; n = 60), alcohol abuse (n = 10) and healthy controls (n = 40). Point-shear wave elastography of the pancreas was performed and quantified as median shear wave velocity (SWV). In the same way, p-SWE of the spleen served as a marker of portal hypertension. The M-ANNHEIM Severity score was used as global marker for disease activity in CP. RESULTS: Compared to healthy controls, pancreatic SWV was significantly elevated in CP (1.38 vs. 0.96 m/s; p < 0.0001, MWU-test). Pancreatic SWV was increased in alcoholic CP but not in hereditary CP. Receiver operating characteristic analysis revealed 1.2 m/s as the optimal cut-off to identify non-heredity-CP subjects (90% specificity; 81% sensitivity; 92% positive predictive value). Pancreatic SWV correlated significantly with the M-ANNHEIM Severity score, severity of CP-typical complications (both p < 0.05, linear regression analysis), morphological changes of the pancreas and need for hospital treatment (both p < 0.05, MWU-test) but not with exocrine or endocrine insufficiency. Pancreatic SWV >1.7 m/s was identified to predict M-ANNHEIM Severity score ≥11 points. Pancreatic SWV was also elevated in LC (1.42 m/s; p < 0.001), correlating with increased splenic SWV. CONCLUSION: Transcutaneous pancreatic p-SWE represents a bedside, cost-effective and non-invasive tool which adds valuable information to the process of diagnosing and monitoring CP. By portal hypertension, an increased pancreatic SWV must be expected.


Sujet(s)
Imagerie d'élasticité tissulaire , Pancréas , Pancréatite chronique , Courbe ROC , Indice de gravité de la maladie , Humains , Imagerie d'élasticité tissulaire/méthodes , Pancréatite chronique/imagerie diagnostique , Mâle , Adulte d'âge moyen , Femelle , Études prospectives , Adulte , Pancréas/imagerie diagnostique , Pancréas/anatomopathologie , Sujet âgé , Cirrhose du foie/imagerie diagnostique , Cirrhose du foie/complications , Études cas-témoins , Sensibilité et spécificité , Valeur prédictive des tests , Hypertension portale/imagerie diagnostique , Hypertension portale/étiologie , Hypertension portale/diagnostic , Rate/imagerie diagnostique , Rate/anatomopathologie
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