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1.
Z Gastroenterol ; 58(9): 877-889, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947633

RESUMO

For 30 years the transjugular intrahepatic portosystemic shunt (TIPS) is successfully used for the treatment of portal hypertension. Indication for TIPS in relation to variceal bleeding and refractory ascites is scientifically documented and defined by national and international guidelines. For rare indications such as hepatorenal syndrome, portal vein thrombosis or the neodjuvant TIPS larger evidence-based studies are missing. An important contraindication and the leading clinical complication after TIPS is the development of hepatic encephalopathy (HE). Reduction of post-TIPS HE is therefore aimed through development of further technical enhancements of the TIPS-stents.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Encefalopatia Hepática/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Rev Med Suisse ; 16(704): 1548-1553, 2020 Sep 02.
Artigo em Francês | MEDLINE | ID: mdl-32880110

RESUMO

Gastrointestinal bleeding related to portal hypertension of cirrhosis is associated with a significant mortality risk (10-20 %). The transjugular intrahepatic portosystemic shunt (TIPS) reduces the hepatic venous pressure gradient. Several studies have evaluated early TIPS insertion (within 72h from diagnostic endoscopy) with the aim of improving outcomes in selected patients at high risk of failure to control bleeding and/or rebleeding. The majority reported an improvement of 6-week and 1-year survival rates and a decrease in failure to control bleeding and rebleeding. Here, we review the available data and discuss the limits of early TIPS in terms of patient identification and access to the procedure.


Assuntos
Hemorragia Gastrointestinal , Hipertensão Portal , Cirrose Hepática , Derivação Portossistêmica Transjugular Intra-Hepática , Hemorragia Gastrointestinal/complicações , Humanos , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Taxa de Sobrevida , Resultado do Tratamento
3.
Intern Med ; 59(17): 2089-2094, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879200

RESUMO

Objective The relationship between gut microbiota and portal hypertension remains unclear. We investigated the characteristics of the gut microbiota in portal hypertension patients with esophago-gastric varices and liver cirrhosis. Methods Thirty-six patients (12 patients with portal hypertension, 12 healthy controls, and 12 non-cirrhosis patients) were enrolled in this university hospital study. Intestinal bacteria and statistical analyses were performed up to the genus level using the terminal restriction fragment length polymorphism method targeting 16S ribosomal RNA genes, with diversified regions characterizing each bacterium. Results Levels of Lactobacillales were significantly higher (p=0.045) and those of Clostridium cluster IV significantly lower (p=0.014) in patients with portal hypertension than in other patients. This Clostridium cluster contains many butanoic acid-producing strains, including Ruminococcace and Faecalibacterium prausnitzii. Clostridium cluster IX levels were also significantly lower (p=0.045) in portal hypertension patients than in other patients. There are many strains of Clostridium that produce propionic acid, and the effects on the host and the function of these bacterial species in the human intestine remain unknown. Regarding the Bifidobacterium genus, which is supposed to decrease as a result of cirrhosis, no significant decrease was observed in this study. Conclusion In the present study, we provided information on the characteristics of the gut microbiota of portal hypertension patients with esophago-gastric varices due to liver cirrhosis. In the future, we aim to develop probiotic treatments following further analyses that include the species level, such as the intestinal flora analysis method and next-generation sequencers.


Assuntos
Bactérias/isolamento & purificação , Microbioma Gastrointestinal , Hipertensão Portal/microbiologia , Cirrose Hepática/complicações , Adulto , Bactérias/genética , Bifidobacterium/isolamento & purificação , Clostridium/isolamento & purificação , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/etiologia , Intestinos/microbiologia , Masculino , Pessoa de Meia-Idade , Probióticos/uso terapêutico , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Streptococcus/isolamento & purificação
4.
Medicine (Baltimore) ; 99(37): e22051, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925738

RESUMO

Addressing pancreaticobiliary disorders concomitant with gastroesophageal varices remains challenging. The goal of this study was to evaluate and compare the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotic and noncirrhotic patients with gastroesophageal varices.We retrospectively analyzed the data of consecutive patients with gastroesophageal varices who underwent ERCP.Two hundred seventy ERCP procedures were performed on 208 patients. The overall technical success rate was 98.5%, and no difference was found between cirrhotic and noncirrhotic patients (98.7% vs 97.7%, P = .511); of these, endoscopic retrograde biliary drainage, endoscopic metal biliary endoprosthesis placement, endoscopic retrograde pancreatic drainage, and stone extraction were conducted in 173/270 (64.1%), 27/270 (10.0%), 26/270 (9.6%), and 116/270 (43.0%) cases, respectively. Endoscopic retrograde biliary drainage and stone extraction were more frequently performed in cirrhotic cases (67.7% versus 45.5%, P = .005; 46.5% versus 25.0%, P = .009, respectively), while the noncirrhotic group had significantly higher rates of endoscopic metal biliary endoprosthesis placement (31.8% versus 5.8%, P = .000) and endoscopic retrograde pancreatic drainage (18.2% versus 8.0%, P = .036) than the cirrhotic group. The overall rate of adverse events was 21.1%, including fever (6.7%), post-ERCP pancreatitis ( 3.0%), hyperamylasemia (6.3%), duodenal papilla bleeding (3.3%), cardiac mucosal laceration (1.1%), and perforation (0.4%). No differences in any of the adverse events were found between the 2 groups. Additionally, gastroesophageal variceal bleeding occurred in 1 patient with grade III varices 7 days after ERCP.ERCP may be effective and safe for patients with gastroesophageal varices, irrespective of the etiologies caused by liver cirrhosis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Cirrose Hepática/complicações , Adulto , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Arq Gastroenterol ; 57(2): 121-125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609163

RESUMO

BACKGROUND: Portal hypertension is one of the complications of cirrhosis and is associated with numerous systemic manifestations, including renal, brain, pulmonary, cardiac and vascular changes. In routine ophthalmological examinations performed at our service, we observed that some children diagnosed with portal hypertension had increased retinal vascular tortuosity. OBJECTIVE: 1. To evaluate the presence of retinal vascular abnormalities (vascular tortuosity) in children diagnosed with portal hypertension; 2. To investigate the association between retinal vascular tortuosity and the presence of gastroesophageal varices in these children; 3. To evaluate the use of clinical and laboratory parameters to predict the presence of gastroesophageal varices in children with portal hypertension. METHODS: This was a cross-sectional and observational study that included patients aged <18 years with a diagnosis of portal hypertension. The participants included were submitted to dilated fundus examination and fundus photography with Visucam (Carl Zeiss Meditec AG) device. Besides, clinical and laboratorial data were collected from the patients' medical records. RESULTS: A total of 72 patients were included in this study, and 36% of them had an increase in retinal vascular tortuosity. Platelet count (P=0.001), bilirubin dosage (P=0.013) and aspartate transaminase dosage (AST) (P=0.042) were associated with the presence of gastroesophageal varices in digestive endoscopy. There was no association between retinal vascular tortuosity and the presence of gastroesophageal varices (P=0.498). CONCLUSION: The results of this study suggest that platelet count, bilirubin dosage, and aspartate transaminase dosage were associated with the presence of gastroesophageal varices in digestive endoscopy. Regarding the retinal findings, we found that there was an increase in retinal vascular tortuosity in 36% of pediatric patients, but no association was found with the presence of gastroesophageal varices.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Adolescente , Criança , Estudos Transversais , Humanos , Cirrose Hepática , Contagem de Plaquetas
7.
Med Clin North Am ; 104(4): 647-662, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505258

RESUMO

Hospitalists often care for patients with liver disease, including those with acute liver injury and failure and patients with complications of decompensated cirrhosis. Acute liver failure is a true emergency, requiring intensive care and oftentimes transfer of the patient to a liver transplant center. Patients with decompensated cirrhosis have complications of portal hypertension, including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. These complications increase the risk of mortality among patients with decompensated cirrhosis. Comanagement by the hospitalist with gastroenterology/hepatology can optimize care, especially for patients being considered for liver transplant evaluation.


Assuntos
Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Cirrose Hepática/terapia , Falência Hepática Aguda/etiologia , Ascite/epidemiologia , Ascite/etiologia , Varizes Esofágicas e Gástricas/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Hipertensão Portal/epidemiologia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Falência Hepática Aguda/epidemiologia , Transplante de Fígado , Peritonite/epidemiologia , Peritonite/etiologia
9.
Zhonghua Yi Xue Za Zhi ; 100(21): 1654-1657, 2020 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-32486601

RESUMO

Objective: To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis. Methods: The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson's correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. The SWE diagnostic performances of Liver (L-SWE), Spleen (S-SWE) were also evaluated. Results: Of all 58 patients, 47 were found HVPG ≥10 mmHg, diagnosed as clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH), which patients are at increased risk of developing complications. Thirty-four patients were found HVPG≥12 mmHg, diagnosed as SPH, which patients were at increased risk of variceal bleeding. Moderate positive correlation was found between L-SWE and HVPG (r=0.42, P<0.01), and S-SWE were significantly correlated with HVPG (r=0.68, P<0.01), while serological models and HVPG were slightly correlated (r=0.36 and 0.28, all P<0.01). The area under the receiver operating characteristic curves of L-SWE, S-SWE and the combination for CSPH were 0.78, 0.88 and 0.89. When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa, patients were at increased risk of developing complications. The area under the receiver operating characteristic curves for SPH were 0.68, 0.81 and 0.77 and the S-SWE had the highest specificity, so when S-SWE was>41.5 kPa, patients were at increased risk of variceal bleeding. Conclusion: L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.


Assuntos
Técnicas de Imagem por Elasticidade , Varizes Esofágicas e Gástricas , Hepatite B , Hipertensão Portal , Hemorragia Gastrointestinal , Humanos , Fígado , Cirrose Hepática , Baço
10.
Nihon Shokakibyo Gakkai Zasshi ; 117(5): 421-429, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32389914

RESUMO

We describe the case of a 60-year-old man who presented at our hospital with abdominal pain and elevated hepatobiliary enzymes. Computed tomography showed portal thrombosis and cavernous transformation as well as increased wall thickness and a stricture in the biliary tract. At that time, the cause of the portal thrombosis was unknown. During follow-up, the blood cell counts (WBCs and platelets) were remarkably increased, and a test performed for the JAK2V617F mutation was positive. We diagnosed the patient with polycythemia vera. Our findings demonstrate that a patient presenting with portal thrombosis, portal biliopathy, and underlying myeloproliferative neoplasms should be carefully examined, even in the absence of the typical blood alterations.


Assuntos
Hipertensão Portal , Policitemia Vera , Trombose Venosa , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta
11.
Proc Natl Acad Sci U S A ; 117(21): 11483-11492, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32404425

RESUMO

Endothelial cell nitric oxide (NO) synthase (eNOS), the enzyme responsible for synthesis of NO in endothelial cells, is regulated by complex posttranslational mechanisms. Sinusoidal portal hypertension, a disorder characterized by liver sinusoidal endothelial cell (SEC) injury with resultant reduced eNOS activity and NO production within the liver, has been associated with defects in eNOS protein-protein interactions and posttranslational modifications. We and others have previously identified novel eNOS interactors, including G protein-coupled receptor (GPCR) kinase interactor 1 (GIT1), which we found to play an unexpected stimulatory role in GPCR-mediated eNOS signaling. Here we report that ß-arrestin 2 (ß-Arr2), a canonical GPCR signaling partner, localizes in SECs with eNOS in a GIT1/eNOS/NO signaling module. Most importantly, we show that ß-Arr2 stimulates eNOS activity, and that ß-Arr2 expression is reduced and formation of the GIT1/eNOS/NO signaling module is interrupted during liver injury. In ß-Arr2-deficient mice, bile duct ligation injury (BDL) led to significantly reduced eNOS activity and to a dramatic increase in portal hypertension compared to BDL in wild-type mice. Overexpression of ß-Arr2 in injured or ß-Arr2-deficient SECs rescued eNOS function by increasing eNOS complex formation and NO production. We also found that ß-Arr2-mediated GIT1/eNOS complex formation is dependent on Erk1/2 and Src, two kinases known to interact with and be activated by ß-Arr2 in response to GCPR activation. Our data emphasize that ß-Arr2 is an integral component of the GIT1/eNOS/NO signaling pathway and have implications for the pathogenesis of sinusoidal portal hypertension.


Assuntos
Óxido Nítrico Sintase Tipo III/metabolismo , Receptores Acoplados a Proteínas-G/metabolismo , Transdução de Sinais/fisiologia , beta-Arrestina 2/metabolismo , Animais , Células Cultivadas , Células Estreladas do Fígado/metabolismo , Hipertensão Portal/metabolismo , Fígado/citologia , Fígado/metabolismo , Hepatopatias/metabolismo , Masculino , Camundongos , Camundongos Knockout , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo III/genética , Ratos , Ratos Sprague-Dawley , Receptores Acoplados a Proteínas-G/genética , Transdução de Sinais/genética , beta-Arrestina 2/genética
12.
PLoS One ; 15(5): e0233778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469999

RESUMO

The selection of the anesthetic regime is a crucial component in many experimental animal studies. In rodent models of liver disease, the combination of ketamine and diazepam (KD), generally by the intramuscular (i.m.) route, has traditionally been the anesthesia of choice for the evaluation of systemic and hepatic hemodynamics but it presents several problems. Here, we compared the performance of inhalational sevoflurane (Sevo) against the KD combination as the anesthesia used for hemodynamic studies involving the measurement of portal pressure in normal rats (Ctrl) and rats with non-cirrhotic portal hypertension induced by partial portal vein ligation (PPVL). Compared with Ctrl rats, rats with PPVL presented characteristic alterations that were not influenced by the anesthetic regime, which included liver atrophy, splenomegaly, increased plasma fibrinogen, decreased alkaline phosphatase and glycemia, and frequent ascites. The use of the KD combination presented several disadvantages compared with the inhalational anesthesia with sevoflurane, including considerable mortality, a higher need of dose adjustments to maintain an optimal depth of anesthesia, increases of heart rate, and alteration of blood biochemical parameters such as the concentration of aspartate aminotransferase, lactate, and lactic dehydrogenase. Rats anesthetized with sevoflurane, on the other hand, presented lower respiratory rates. Importantly, the anesthetic regime did not influence the measurement of portal pressure either in Ctrl or PPVL rats, with the increase of portal pressure being similar in Sevo- and KD- anesthetized groups of PPVL rats compared with their respective control groups. Overall, our results suggest that anesthesia with sevoflurane is preferable to the combination of KD for performing systemic and hepatic hemodynamic studies in rats with non-cirrhotic portal hypertension.


Assuntos
Diazepam/farmacologia , Hipertensão Portal/tratamento farmacológico , Ketamina/farmacologia , Pressão na Veia Porta/efeitos dos fármacos , Sevoflurano/farmacologia , Anestesia por Inalação , Anestesiologia , Anestésicos Dissociativos/farmacologia , Anestésicos Inalatórios/farmacologia , Animais , Modelos Animais de Doenças , Fígado/irrigação sanguínea , Masculino , Veia Porta/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
13.
PLoS One ; 15(5): e0233350, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437441

RESUMO

BACKGROUND: Serum-ascites albumin gradient (SAAG) remains the most sensitive and specific marker for the differentiation of ascites due to portal hypertension from ascites due to other causes. SAAG has some limitations and may fail in selected conditions. Voltammetric analysis (VA) has been used for the detection of electroactive species of biological significance and has proven effective for detection infections in biological fluids. AIMS: In this study, we compared the accuracy of voltammetric analysis (VA) with that of SAAG to differentiate ascites due to portal hypertension from that having a different origin. METHODS: 80 ascites samples were obtained from patients undergoing paracentesis at the Campus Bio-Medico Hospital of Rome. VA was performed using the BIONOTE device. The ability of VA to discriminate ascitic fluid etiology and biochemical parameters was evaluated using Partial Least Square Discriminant Analysis (PLS-DA), with ten-fold cross-validations. RESULTS: Mean age was 68.6 years (SD 12.5), 58% were male. Ascites was secondary to only portal hypertension in 72.5% of cases (58 subjects) and it was secondary to a baseline neoplastic disease in 27.5% of cases (22 subjects). Compared to SAAG≥1.1, e-tongue predicted ascites from portal hypertension with a better accuracy (92.5% Vs 87.5%); sensitivity (98.3% Vs 94.8%); specificity (77.3% Vs 68.2%); predictive values (PPV 91.9% Vs 88.7% and NPV 94.4% Vs 83.3%). VA correctly classified ascites etiology in 57/58 (98.2%) of cases with portal hypertension and in 17/22 (77.2%) of cases with malignancy. Instead, VA showed poor predictive capacities towards total white blood count and polymorphonuclear cell count. CONCLUSIONS: According to this proof of concept study, VA qualifies as a promising low-cost and easy method to discriminate between ascites secondary to portal hypertension and ascites due to malignancy.


Assuntos
Ascite/diagnóstico , Ascite/etiologia , Técnicas Eletroquímicas/métodos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Neoplasias/complicações , Neoplasias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Albuminas/análise , Líquido Ascítico/química , Biomarcadores/análise , Técnicas de Química Analítica/métodos , Técnicas de Química Analítica/estatística & dados numéricos , Diagnóstico Diferencial , Técnicas Eletroquímicas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão , Estudo de Prova de Conceito , Albumina Sérica Humana/análise
14.
PLoS One ; 15(4): e0231701, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302330

RESUMO

Liver cirrhosis represents the common end-stage of chronic liver diseases regardless of its etiology. Patients with compensated disease are mostly asymptomatic, however, progression to a decompensated disease stage is common. The available stratification strategies are often unsuitable to identify patients with a higher risk for disease progression and a limited prognosis. SIBLINGs, soluble glycophosphoproteins, are secreted into the blood by immune-cells. While osteopontin, the most prominent member of the SIBLINGs family, has been repeatedly associated with liver cirrhosis, data on the diagnostic and/or prognostic value of bone sialoprotein (BSP) are scarce and partly inconclusive. In this study, we analyzed the diagnostic and prognostic potential of circulating BSP in comparison to other standard laboratory markers in a large cohort of patients with liver cirrhosis receiving transjugular intrahepatic portosystemic shunt (TIPS). Serum levels of BSP were similar in patients with different disease stages and were not indicative for prognosis. Interestingly, BSP serum levels did correlate inversely with portal pressure, as well as its surrogates such as platelet count, the portal vein cross-sectional area and correlated positively with the portal venous velocity. In summary, our data highlight that BSP might represent a previously unrecognized marker for portal hypertension in patients with liver cirrhosis.


Assuntos
Hipertensão Portal/diagnóstico , Sialoproteína de Ligação à Integrina/sangue , Cirrose Hepática/complicações , Pressão na Veia Porta/fisiologia , Adulto , Idoso , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Hipertensão Portal/sangue , Hipertensão Portal/fisiopatologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Veia Porta/fisiopatologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
Radiol Med ; 125(10): 1008-1011, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32306200

RESUMO

PURPOSE: This manuscript reports on a preliminary experience concerning emborrhoid in patients affected by cirrhotic portal hypertension; furthermore, a novel customized technique of coils release, named "Spaghetti technique," is described. MATERIALS AND METHODS: Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated. Clinics and hemoglobin values were evaluated to objectively assess clinical conditions up to 3 months follow-up. Embolizations were performed with fibered coils, oversized, released stretched and not packed. RESULTS: Technical success, intended as occlusion of all superior hemorrhoidal artery branches, was 100%. In two patients, inferior hemorrhoidal arteries were embolized too. No patients reported major or minor complications. At 3-month follow-up, clinical improvement was obtained in four of the five patients; hemoglobin values improved or remained stable in the whole sample. CONCLUSIONS: Based on this limited experience, emborrhoid seems to be safe and effective at 3-month follow-up to improve symptoms in patients with cirrhotic portal hypertension and chronic anemia due to hemorroidal bleeding; the stretched fashion to release oversized coils provides effective embolization.


Assuntos
Embolização Terapêutica/métodos , Hemorragia/terapia , Hemorroidas/terapia , Hipertensão Portal/complicações , Idoso , Anemia/etiologia , Anemia/terapia , Embolização Terapêutica/instrumentação , Feminino , Hemorragia/complicações , Hemorroidas/complicações , Humanos , Cirrose Hepática/complicações , Masculino , Artérias Mesentéricas , Pessoa de Meia-Idade
16.
Cochrane Database Syst Rev ; 3: CD012056, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32227478

RESUMO

BACKGROUND: Cystic fibrosis is an autosomal recessive inherited defect in the cystic fibrosis transmembrane conductance regulator (CFTR) gene resulting in abnormal regulation of salt and water movement across the membranes. In the liver this leads to focal biliary fibrosis resulting in progressive portal hypertension and end-stage liver disease in some individuals. This can be asymptomatic, but may lead to splenomegaly and hypersplenism, development of varices and variceal bleeding, and ascites; it has negative impact on overall nutritional status and respiratory function in this population. Prognosis is poor once significant portal hypertension is established. The role and outcome of various interventions for managing advanced liver disease (non-malignant end stage disease) in people with cystic fibrosis is currently unidentified. This is an updated version of a previously published review. OBJECTIVES: To review and assess the efficacy of currently available treatment options for preventing and managing advanced liver disease in children and adults with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 19 November 2019. We also searched the reference lists of relevant articles and reviews and online trials registries. Date of last search: 01 January 2020. SELECTION CRITERIA: Any published and unpublished randomised controlled trials and quasi-randomised controlled trials of advanced liver disease in cystic fibrosis with cirrhosis or liver failure, portal hypertension or variceal bleeding (or both). DATA COLLECTION AND ANALYSIS: Authors independently examined titles and abstracts to identify potentially relevant trials, but none were eligible for inclusion in this review. MAIN RESULTS: A comprehensive search of the literature did not identify any published eligible randomised controlled trials. AUTHORS' CONCLUSIONS: In order to develop the best source of evidence, there is a need to undertake randomised controlled trials of interventions for preventing and managing advanced liver disease in adults and children with cystic fibrosis.


Assuntos
Fibrose Cística/complicações , Hepatopatias/terapia , Adulto , Criança , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Hipertensão Portal/prevenção & controle , Hepatopatias/etiologia , Hepatopatias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
S D Med ; 73(2): 61-66, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32135053

RESUMO

While portal-systemic encephalopathy is a common entity in cirrhotic patients, it is less frequent in non-cirrhotic patients. We are reporting a case of a 68-year-old female who presented with unresponsiveness for the second time in six months. She underwent extensive evaluation for liver disease with ultrasonography and computerized tomography of the abdomen, testing for causes of liver disease including testing for viral hepatitis was negative. A liver biopsy was done clearing any doubt about the presence of significant liver disease or clinically significant portal hypertension. With absence of liver disease hence lower likelihood of portal-systemic encephalopathy (PSE) we evaluated for other causes of encephalopathy with unremarkable neuroimaging including brain MRI and head CT, unremarkable CSF analysis and EEG showing no seizure activity. Given the negative workup and the high ammonia level with the significant clinical response to ammonia lowering therapy we further evaluated the patient for other causes of PSE with Doppler ultrasonography of the liver and eventually angiography of the portal system with the high suspicion for a portosystemic shunt as a cause of her encephalopathy. A shunt from the inferior mesenteric vein to the left renal vein was diagnosed and successfully occluded utilizing coil embolization. The patient recovered normal mentation and was eventually discharged home. This case sheds light on the importance of diagnosing portosystemic shunts leading to encephalopathy, as occlusion of the shunt can correct the encephalopathy and help prevent further episodes.


Assuntos
Encefalopatias , Encefalopatia Hepática , Hipertensão Portal , Derivação Portossistêmica Cirúrgica , Idoso , Feminino , Encefalopatia Hepática/etiologia , Humanos , Derivação Portossistêmica Cirúrgica/efeitos adversos
18.
Zhonghua Wai Ke Za Zhi ; 58(3): 183-188, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187922

RESUMO

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hipertensão Portal/cirurgia , Cirrose Hepática/cirurgia , China , Humanos , Laparoscopia , Esplenectomia
19.
Surgery ; 167(6): 926-932, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32113581

RESUMO

BACKGROUND: Portal hypertension after hepatectomy is associated with impaired postoperative recovery. Terlipressin decreased portal vein pressure in patients with variceal bleeding and improved patient survival, but the role of postoperative terlipressin treatment for patients who underwent liver resection is not clear. METHODS: We determined the effect of terlipressin on portal vein pressure in patients with portal vein pressure >12 mmHg after hepatectomy. If portal vein pressure was decreased (ie, Responders), a continuous infusion of terlipressin at 2 mg/day for 4 days was given. The incidence of posthepatectomy liver failure, abdominal drainage, acute kidney injury, operative complications, and side-effects of terlipressin in the Responders were compared with those whose portal vein pressure did not decrease (ie, non-Responders) and patients whose portal vein pressure was ≤12 mmHg after hepatectomy (low portal vein pressure group). RESULTS: We recruited 110 patients, 65 of whom were eligible for terlipressin administration. Portal vein pressure decreased in 46 patients (71%) with the mean portal vein pressure decreasing from 15.8 ± 2.6 mmHg to 14.3 ± 2.9 mmHg (P < .001). The median [interquartile range] postoperative abdominal drainage for the first 3 postoperative days was less in the Responders than in the non-Responders (350 mL [228-573] vs 730 mL [330-980]; P = .004). Incidence of posthepatectomy liver failure in the Responders was less than the non-Responders (26% vs 53%, P = .04). Acute kidney injury, operative complications, and side-effects of terlipressin were not different between groups. CONCLUSION: Terlipressin decreased posthepatectomy portal vein pressure and may decrease the incidence of posthepatectomy liver failure and postoperative abdominal drainage (NCT03352349).


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Hepatectomia , Veia Porta , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Drenagem/estatística & dados numéricos , Feminino , Humanos , Hipertensão Portal/prevenção & controle , Falência Hepática/prevenção & controle , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
20.
Korean J Radiol ; 21(4): 387-401, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32193887

RESUMO

Radiomics and deep learning have recently gained attention in the imaging assessment of various liver diseases. Recent research has demonstrated the potential utility of radiomics and deep learning in staging liver fibroses, detecting portal hypertension, characterizing focal hepatic lesions, prognosticating malignant hepatic tumors, and segmenting the liver and liver tumors. In this review, we outline the basic technical aspects of radiomics and deep learning and summarize recent investigations of the application of these techniques in liver disease.


Assuntos
Aprendizado Profundo , Hipertensão Portal/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Área Sob a Curva , Bases de Dados Factuais , Humanos , Hipertensão Portal/patologia , Processamento de Imagem Assistida por Computador , Cirrose Hepática/patologia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Neoplasias Hepáticas/patologia , Curva ROC
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