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Gastroenterology 2021 May 11. Epub 2021 May 11.

Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada.

Am J Gastroenterol 2021 May 13. Epub 2021 May 13.

Division of Hepatology, Bruce W Carter VA Medical Center, Miami, Florida, USA; Department of Medicine, Jackson Memorial Hospital, Miami, Florida, USA; Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Gastroenterology and Hepatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA; Division of Gastroenterology and Hepatology, VA Connecticut Healthcare System, West Haven, Connecticut, USA.

Introduction: Patients with cirrhosis and men have been under-represented in most studies examining the clinical benefit of response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC). The aim of this study was to study the association of UDCA response and liver-related death or transplantation, hepatic decompensation, and hepatocellular carcinoma (HCC) in patients with PBC cirrhosis.

Methods: We conducted a retrospective cohort study of veterans, predominantly men, with PBC and compensated cirrhosis to assess the association of UDCA response with the development of all-cause and liver-related mortality or transplantation, hepatic decompensation, and HCC using competing risk time-updating Cox proportional hazards models. Read More

Biomed Res Int 2021 20;2021:5595614. Epub 2021 Apr 20.

Department of Hepatology, First Hospital of Jilin University, Xinmin Street, No. 71, Changchun, Jilin Province 130021, China.

Background And Aims: There are few studies on the prevalence and clinical characteristics of portopulmonary hypertension (POPH) in patients with portal hypertension. In addition, invasive right heart catheterization further limits the clinical diagnosis of POPH patients.

Methods: From January 2018 to December 2019, 1004 patients with portal hypertension were treated in the Department of Hepatology, the First Hospital of Jilin University. Read More

Ann Transl Med 2021 Apr;9(8):729

Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH University Hospital Aachen, Aachen, Germany.

Liver fibrosis is the excessive expression and accumulation of extracellular matrix proteins in the liver. Fibrotic scarring occurs as the consequence of chronic injury and inflammation. While the successful treatment of hepatitis B and C reduced the burden of liver disease related to viral hepatitis, non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) are nowadays the leading causes of hepatic fibrosis worldwide. Read More

Ann Transl Med 2021 Apr;9(7):540

Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Background: Endoscopic therapy has been widely applied to prevent variceal rebleeding, but data addressing the effect of endoscopic variceal eradication (VE) are lacking. We aimed to clarify the clinical impact of VE and reveal the long-term incidence and mortality of gastrointestinal rebleeding.

Methods: This prospective study included 228 cirrhotic patients who underwent secondary prophylaxis for variceal bleeding and achieved VE through a systematic procedure we proposed as endoscopic sequential therapy (EST). Read More

BMC Gastroenterol 2021 May 13;21(1):219. Epub 2021 May 13.

Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania.

Background: Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. Read More

Pediatr Radiol 2021 May 13. Epub 2021 May 13.

Department of Pediatric Radiology, University Children's Hospital Geneva, 6 rue Willy Donzé, CH 1211, Genéve 14, Suisse.

Background: Acoustic radiation force impulse (ARFI) imaging is a noninvasive ultrasound elastography technique for evaluating tissue stiffness. The association of liver and spleen stiffness provides additional information in the assessment of portal hypertension. The technique and normal values of spleen stiffness by point shear wave elastography (p-SWE) in pediatrics have not been well documented. Read More

Am J Gastroenterol 2021 Apr;116(4):723-732

1Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; 2Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; 3Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; 4Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria; 5Service d'Hépatologie CHU Toulouse Rangueil, Institut Cardiomet et Université Paul Sabatier, Toulouse, France; 6UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Centre, Royal Free Hospital and UCL, London, United Kingdom; 7Swiss Liver Center, UVCM, Inselspital, Department of Biomedical Research, University of Bern, Bern, Switzerland; 8Liver Unit, Regional Institute of Gastroenterology and Hepatology "Octavian Fodor," University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania; 9Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada; 10Division of Internal Medicine II, Krankenhaus Barmherzige Brüder, Vienna, Austria; 11Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.

Introduction: We aimed to explore the prevalence of portal hypertension in the most common etiologies of patients with compensated advanced chronic liver disease (cACLD) and develop classification rules, based on liver stiffness measurement (LSM), that could be readily used to diagnose or exclude clinically significant portal hypertension (CSPH) in clinical practice.

Methods: This is an international cohort study including patients with paired LSM/hepatic venous pressure gradient (HVPG), LSM ≥10 kPa, and no previous decompensation. Portal hypertension was defined by an HVPG >5 mm Hg. Read More

Hepatol Int 2021 May 12. Epub 2021 May 12.

Digestive Disease Research Center, Medical University South Carolina, Charleston, SC, USA.

Zhonghua Gan Zang Bing Za Zhi 2021 Apr;29(4):373-376

Department of Gastroenterology, the Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430000, China.

Clin Liver Dis 2021 Feb 17;25(1):103-120. Epub 2020 Oct 17.

Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, 1120 Northwest 14th #1115, Miami, FL 33136, USA.

Complications of portal hypertension such as gastroesophageal variceal hemorrhage, ascites, and spontaneous bacterial peritonitis, as well as pulmonary complications, are often responsible for diminished quality of life, excess morbidity and mortality, increased health care resource use and expenditure, and dropout from the liver transplant (LT) waiting list. Therefore, the care of LT candidates on the waiting list must be centered on anticipation and prompt intervention for these complications. Read More

Hepatology 2021 May 11. Epub 2021 May 11.

Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

We read with great interest the article by Elkrief L et al.(1) titled "Liver stiffness by transient elastography to detect porto-sinusoidal vascular liver disease (PSVD) with portal hypertension". The authors have included a large number of patients of this relatively infrequent disease and have tried to address the important clinical problem of differentiating PSVD from compensated cirrhosis, non-invasively. Read More

J Thromb Haemost 2021 May 11. Epub 2021 May 11.

Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service (NHS) Foundation Trust, London, UK.

Patients with cirrhosis frequently have complex alterations in their hemostatic system. Although routine diagnostic tests of hemostasis in cirrhosis (platelet count, prothrombin time, fibrinogen level) are suggestive of a bleeding tendency, it is now widely accepted that these tests do not reflect hemostatic competence in this population. Rather, patients with cirrhosis appear to have a rebalanced hemostatic system with hypercoagulable elements. Read More

J Gastroenterol Hepatol 2021 May 11. Epub 2021 May 11.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background And Aim: Patients indicated to transjugular intrahepatic portosystemic shunt (TIPS) placement may have splenectomy history due to thrombocytopenia. This study aimed to evaluate the effect of prior splenectomy on TIPS procedure and post-TIPS outcomes.

Methods: We conducted a longitudinal analysis based on a cohort of 284 patients with cirrhosis submitted to TIPS. Read More

BMJ Case Rep 2021 May 10;14(5). Epub 2021 May 10.

Department of Surgery, Marunouchi Hospital, Matsumoto, Nagano, Japan.

BMC Gastroenterol 2021 May 10;21(1):214. Epub 2021 May 10.

Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, Guangdong, China.

Background: Portal hypertension induced esophageal and gastric variceal bleeding is the main cause of death among patients of decompensated liver cirrhosis. Therefore, a standardized, biomarker-based test, to make an early-stage non-invasive risk assessment of portal hypertension, is highly desirable. However, no fit-for-purpose biomarkers have yet been identified. Read More

Liver Int 2021 May 9. Epub 2021 May 9.

Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, NM, USA.

Background: Fresh frozen plasma (FFP) transfusion is often used in the management of acute variceal hemorrhage (AVH) despite best practice advice suggesting otherwise.

Objective: We investigated if FFP transfusion affects clinical outcomes in AVH.

Design, Setting And Patients: We performed a retrospective cohort study of 244 consecutive, eligible patients admitted to 5 tertiary health care centers between 2013 - 2018 with AVH. Read More

Cardiovasc Diagn Ther 2021 Apr;11(2):577-590

Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.

Congenital heart diseases (CHD) can be associated with liver dysfunction. The cause for liver impairment can result out of a wide spectrum of different causes, including liver congestion, hypoxemia or low cardiac output. Fortunately, most CHD show a good long-term outcome from a cardiac perspective, but great attention should be paid on non-cardiac health problems that develop frequently in patients suffering from CHD. Read More

Biomed Res Int 2021 17;2021:5530004. Epub 2021 Apr 17.

Department of Ultrasonic Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China 710032.

Objectives: To investigate the performance of spleen stiffness (SS) by using two-dimensional shear-wave elastography (2D-SWE) for assessing the severity of gastroesophageal varices (GEVs) after transjugular intrahepatic portosystemic shunt (TIPS).

Methods: 102 eligible patients were categorized as in the post-TIPS short-term ( = 69) and long-term ( = 38) follow-up groups. The performance of SS by using 2D-SWE for evaluating the severity of GEVs was compared with liver stiffness (LS), spleen stiffness-to-liver stiffness ratio (SS/LS), liver stiffness spleen-diameter-to-platelet-ratio score (LSPS), portal hypertension (PH) risk score, platelet count-to-spleen diameter ratio (PSR), and varices risk score by using receiver operating characteristic (ROC) curve and DeLong test. Read More

World J Hepatol 2021 Apr;13(4):421-432

Department ofGastroenterology and Hepatology, Changi General Hospital, Singapore 529889, Singapore.

Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction. Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis, large-volume paracentesis and hepatorenal syndrome. Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients. Read More

J Am Coll Radiol 2021 May;18(5S):S153-S173

Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, Chair, FMLH credentials committee, Division chief of IR at Medical College of Wisconsin.

Cirrhosis is a heterogeneous disease that cannot be studied as a single entity and is classified in two main prognostic stages: compensated and decompensated cirrhosis. Portal hypertension, characterized by a pathological increase of the portal pressure and by the formation of portal-systemic collaterals that bypass the liver, is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. A myriad of treatment options exists for appropriately managing the most common complications of portal hypertension, including acute variceal bleeding and refractory ascites. Read More

J Exp Med 2021 Jul 6;218(7). Epub 2021 May 6.

Department of Internal Medicine (Digestive Diseases), Yale School of Medicine, New Haven, CT.

Portal hypertension is a major contributor to decompensation and death from liver disease, a global health problem. Here, we demonstrate homozygous damaging mutations in GIMAP5, a small organellar GTPase, in four families with unexplained portal hypertension. We show that GIMAP5 is expressed in hepatic endothelial cells and that its loss in both humans and mice results in capillarization of liver sinusoidal endothelial cells (LSECs); this effect is also seen when GIMAP5 is selectively deleted in endothelial cells. Read More

J Indian Assoc Pediatr Surg 2021 Jan-Feb;26(1):54-56. Epub 2021 Jan 11.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.

Congenital intrahepatic arterioportal fistulas are rare causes of presinusoidal portal hypertension in children. A rare case of arterioportal fistula in an infant is being reported. This report also highlights the need for long-term surveillance in such cases, despite being a benign pathology. Read More

BMC Med Inform Decis Mak 2021 May 5;21(1):149. Epub 2021 May 5.

Department of Radiology, Limerick University Hospital, St Nessan's Rd, Dooradoyle, Co. Limerick, V94 F858, Ireland.

Purpose: Transjugular intrahepatic portosystemic shunt (TIPS) procedure is an established procedure carried out by interventional radiologists to achieve portal decompression and to manage the complications of portal hypertension. The aim of this study was to evaluate the quality and readability of information available online for TIPS procedure.

Methods: Websites were identified using the search terms "TIPS procedure", "TIPSS procedure", "transjugular intrahepatic portosystemic shunt procedure", with the first 25 pages from the three most popular search engines (Google, Bing and Yahoo) being selected for evaluation with a total of 225. Read More

J Clin Imaging Sci 2021 26;11:25. Epub 2021 Apr 26.

Department of Radiology, NorthShore University Health Sciences, Evanston, Illinois, United States.

Objectives: Measurement of hepatic vein pressures is the accepted gold standard for the evaluation of portal hypertension. This study was conducted to evaluate the correlation between hepatic vein pressure measurements and histologic findings from transjugular liver biopsies. The hypothesis was that higher hepatic venous pressure gradients would correlate with a histologic diagnosis of cirrhosis. Read More

Am J Med Sci 2020 Nov 2. Epub 2020 Nov 2.

Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, United States; Roudebush Veterans Administration Medical Center, Indianapolis, IN, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address:

Background: Complications of patients with liver disease generally occurs as the consequence of advanced fibrosis and portal hypertension. Non-invasive tools to predict the complications may allow for better risk-stratification and medical management in patients with cirrhosis. The goals of this study were to determine the utility of CT-scan based liver and spleen volume measurement in association with complications and outcomes in patients with cirrhosis. Read More