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Curr Treat Options Gastroenterol 2019 Apr 12. Epub 2019 Apr 12.

Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA.

Purpose Of Review: Patients with cirrhosis are at high risk of developing serious infections. Bacterial infections remain the most common cause of morbidity and mortality in these patients. This review is focused on the prevalence of infections in those with cirrhosis, including multidrug-resistant (MDR) pathogens, pathogenesis of infection-related acute-on-chronic liver failure (ACLF), current treatment recommendations, and prophylactic strategies in patients with cirrhosis. Read More

GE Port J Gastroenterol 2019 Mar 8;26(2):83-89. Epub 2018 Jun 8.

aDepartment of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

Background: The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results.

Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients.

Materials And Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital-, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Read More

GE Port J Gastroenterol 2019 Mar 25;26(2):79-80. Epub 2018 May 25.

Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.

Curr Treat Options Gastroenterol 2019 Apr 9. Epub 2019 Apr 9.

Division of Nephrology (Kidney-Liver Program), Department of Medicine, University of Washington, 356521, 1959 NE Pacific Street, Seattle, WA, 98195-6521, USA.

Purpose Of Review: Albumin has repeatedly been shown to be beneficial in treating patients with decompensated cirrhosis. We reviewed the medical literature regarding indications for the use of intravenous albumin in cirrhosis, with particular focus on the ways in which albumin can help mitigate hepatorenal physiology.

Recent Findings: Albumin has long been used as the preferred agent for volume expansion in patients with decompensated cirrhosis. Read More

Dig Liver Dis 2019 Mar 31. Epub 2019 Mar 31.

Department of Medicine II, University Hospital, LMU Munich, Germany. Electronic address:

Background/aims: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of advanced cirrhosis. By studying the susceptibility of isolated organisms and analyzing empirical antibiotic therapy combined with clinical outcomes, we aimed to find an improved empirical antibiotic therapy by considering the individual acute-on-chronic liver failure (ACLF) grade for patients with or without sepsis.

Methods: Clinical outcomes of 182 patients were assessed retrospectively with multivariable regression analysis. Read More

J Gastroenterol Hepatol 2019 Mar 14. Epub 2019 Mar 14.

Hepatology Department, National Liver Institute, University of Menoufia, Shebeen El-Kom, Egypt.

Background And Aim: Upper gastrointestinal bleeding (UGIB) is a serious complication of portal hypertension in cirrhotic patients. The objective of this study is to identify the risk factors for morbidity and mortality occurring after an UGIB attack.

Methods: A total of 1097 UGIB attacks in 690 patients with liver cirrhosis were studied. Read More

Antiinflamm Antiallergy Agents Med Chem 2019 Apr 1. Epub 2019 Apr 1.

Tropical Medicine & Infectious Diseases, Tanta University Faculty of Medicine, Tanta. Egypt.

Background & Aims: Diagnosis of Spontaneous bacterial peritonitis (SBP) depends mainly on ascetic fluid culture which may be negative inspite of clinical suggestion of SBP and high ascetic fluid neutrophilic count. This study aimed to evaluate the biological importance of amyloid A biomarker in both serum and ascetic fluid to diagnose SBP as early as possible and to compare it to other markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR)).

Methods: This study included 37 patients with hepatic ascites; twenty two of them had SBP, and 15 patients did not. Read More

Mediators Inflamm 2019 25;2019:7537649. Epub 2019 Feb 25.

Department of Gastroenterology, Hepatology and Infectious Diseases, University Magdeburg, Leipzigerstrasse 44, 39120 Magdeburg, Germany.

Liver cirrhosis yearly causes 1.2 million deaths worldwide, ranking as the 10th leading cause of death in the most developed countries. High susceptibility to infections along with a significant risk for infection-related mortality justifies the description of liver cirrhosis as the world's most common immunodeficiency syndrome. Read More

Liver Int 2019 Mar 28. Epub 2019 Mar 28.

Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.

Background And Aims: Several antibiotic treatments aiming to prevent spontaneous bacterial peritonitis in cirrhotic patients with low-protein content in ascitic fluid have been tested; however, there is limited data on the comparative efficacy of these regimens. We assessed their comparative efficacy through a network meta-analysis and using GRADE criteria to appraise quality of evidence.

Methods: Through literature review through October 2018, we identified 10 randomized-controlled trials comparing antibiotic treatments (norfloxacin, ciprofloxacin, trimethoprim/sulfamethoxazole, and rifaximin) with each other or placebo. Read More

Am J Gastroenterol 2019 Apr;114(4):553-555

Division of Hepatology, Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White All Saints Medical Center, Fort Worth, Texas, USA.

Spontaneous bacterial peritonitis (SBP) is associated with risk of acute on chronic liver failure (ACLF). Current guidelines recommend primary and secondary antibiotic prophylaxis for patients with cirrhosis and ascites who are at risk of a first episode and to prevent recurrence, respectively. Factors associated with prophylaxis failure leading to SBP, ACLF, and increased mortality are not well established. Read More

Pak J Med Sci 2019 Jan-Feb;35(1):4-9

Anwaar A. Khan, MACP, FACG, FRCP, FCPS. Consultant Gastroenterologist, Doctors Hospital & Medical Center Ex- Dean and Professor of Gastroenterology, Shaikh Zayed Post Graduate Medical Institute, Lahore, Pakistan.

Objective: To determine 3 generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment.

Methods: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Read More

Gastroenterology 2019 Mar 14. Epub 2019 Mar 14.

Infectious Diseases Unit, IRCCS "San Matteo", Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy. Electronic address:

World J Gastroenterol 2019 Feb;25(8):888-908

Liver Unit/Division of Integrative Systems Medicine and Digestive Disease, Imperial College London, London W2 1NY, United Kingdom.

Due to the restrictions of liver transplantation, complication-guided pharmacological therapy has become the mainstay of long-term management of cirrhosis. This article aims to provide a complete overview of pharmacotherapy options that may be commenced in the outpatient setting which are available for managing cirrhosis and its complications, together with discussion of current controversies and potential future directions. PubMed/Medline/Cochrane Library were electronically searched up to December 2018 to identify studies evaluating safety, efficacy and therapeutic mechanisms of pharmacological agents in cirrhotic adults and animal models of cirrhosis. Read More

Indian J Anaesth 2019 Feb;63(2):119-125

Department of Epidemiology, ILBS, New Delhi, India.

Background And Aims: Blood transfusion is unpredictable in liver transplantation and is associated with increased patient morbidity, mortality and cost. This retrospective analysis was conducted to detect factors which could predict intraoperative transfusion of more than four units of packed red blood cells (PRBCs) during elective living donor liver transplantation (LDLT).

Methods: This was a single-centre retrospective study. Read More

J Hosp Med 2019 Mar;14(3):157-160

Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia.

Hepatic encephalopathy (HE) is characterized by altered sensorium and is the most common indication for hospitalization among patients with cirrhosis. Liver societal guidelines for inpatient HE revolve around identification of potential precipitants. In this retrospective study, we aimed to determine adherence to societal guidelines for evaluation of HE in 78 inpatients. Read More

Front Immunol 2019 8;10:69. Epub 2019 Feb 8.

Department of Internal Medicine I, Goethe University Clinic Frankfurt, Frankfurt, Germany.

Acquired dysfunctional immunity in cirrhosis predisposes patients to frequent bacterial infections, especially spontaneous bacterial peritonitis (SBP), leading to systemic inflammation that is associated with poor outcome. But systemic inflammation can also be found in the absence of a confirmed infection. Detection of bacterial DNA has been investigated as a marker of SBP and as a predictor of prognosis. Read More

Iran J Public Health 2018 Dec;47(12):1883-1890

Tianjin Medical University General Hospital, Tianjin 300052, China.

Background: We aimed to explore risk factors for patients with liver cirrhosis complicated with spontaneous bacterial peritonitis (SBP).

Methods: The clinical data of 195 patients with liver cirrhosis complicated with SBP (study group), admitted from March 2014 to March 2018 in Tianjin Medical University General Hospital, Tianjin, China and 195 patients without liver cirrhosis complicated with SBP (control group) were retrospectively analyzed. Clinical manifestations of patients and laboratory findings were analyzed. Read More

Trop Doct 2019 Feb 20:49475519830265. Epub 2019 Feb 20.

1 Hepatology and Gastroenterology Department, National Liver Institute, Menofia University, Menofia Governate, Egypt.

Cirrhotic patients with ascites are at high risk of developing spontaneous bacterial peritonitis (SBP). After exclusion of patients with acute kidney injury (AKI) or other infections, urinary neutrophil gelatinase-associated lipocalin (NGAL) levels were compared between two matched groups of Egyptian cirrhotic patients with ascites, mostly secondary to hepatitis C infection (98%). Group 1 had SBP (n = 41) and group 2 did not (n = 45). Read More

BMJ Case Rep 2019 Feb 13;12(2). Epub 2019 Feb 13.

Internal Medicine, Sparrow Hospital, Lansing, Michigan, USA.

Dig Dis Sci 2019 Feb 14. Epub 2019 Feb 14.

Liver Center, Beth Israel Deaconess Medical Center, 110 Francis St, LMOB 8E, Boston, MA, 02215, USA.

Objectives: There are few studies addressing the impact of cephalosporin and quinolone resistance on hospital length of stay and mortality in spontaneous bacterial peritonitis (SBP). We aim to describe the shifting epidemiology of SBP at our institution and its impact on clinical outcomes.

Methods: We performed a single-center retrospective cohort study of all cases of SBP from 2005 to 2015 at a transplant center. Read More

J Infect Chemother 2019 Feb 6. Epub 2019 Feb 6.

Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Read More

Hepatol Int 2019 Mar 8;13(2):234-244. Epub 2019 Feb 8.

Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.

Background: Current knowledge suggests that proton pump inhibitors (PPIs) are associated with an increased risk of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP). These conditions and PPI use are related to gut microbiota. The aim of this study is to research the changes in gut microbiota caused by PPI in patients with chronic liver disease. Read More

Am J Emerg Med 2019 Jan 25. Epub 2019 Jan 25.

Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, United States of America.

Study Objective: To determine the sensitivity of a highly sensitive bedside leukocyte esterase reagent strip (RS) for detection of spontaneous bacterial peritonitis (SBP) in emergency department (ED) ascites patients undergoing paracentesis.

Methods: We conducted a prospective, observational cohort study of ED ascites patients undergoing paracentesis at two academic facilities. Two practitioners, blinded to each other's results, did a bedside RS analysis of the peritoneal fluid in each patient and documented the RS reading at 3-min according to manufacturer-specified colorimetric strip reading as either "negative", "trace", "small", or "large". Read More

J Hepatol 2019 May 2;70(5):1028-1030. Epub 2019 Feb 2.

Dept. of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Italy.

J Hepatol 2019 May 2;70(5):1027-1028. Epub 2019 Feb 2.

Infectious Diseases Unit, IRCCS "San Matteo", Pavia, Italy; Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy. Electronic address:

Intern Emerg Med 2019 Jan 31. Epub 2019 Jan 31.

Tropical Medicine Department, Faculty of Medicine, Zagazig University Hospitals, Zagazig, Egypt.

The influence of vitamin D, 25-hydroxyvitamin D (25(OH)D), deficiency on hepatitis C virus (HCV)-related cirrhosis had been poorly elucidated especially in patients with hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP). We aimed to investigate the association between vitamin D deficiency and the risk of SBP or HE, including the mortality rate. Serum 25(OH)D levels were prospectively determined in 135 patients. Read More

World J Hepatol 2019 Jan;11(1):74-85

Department of Internal Medicine, the Queen's Medical Center, Honolulu, HI 968132, United States.

Background: Chronic liver disease and cirrhosis is the 12 leading cause of death in the United States. Patients with decompensated-cirrhosis, especially with hepatic encephalopathy/coma (HC), have a higher rate of early readmission and contribute to higher healthcare cost.

Aim: To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. Read More

Clin Transl Gastroenterol 2019 Jan;10(1):e00002

Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.

Objectives: Common nucleotide-binding oligomerization domain containing 2 (NOD2) gene variants have been associated with bacterial infections (BIs) in cirrhosis, in particular, spontaneous bacterial peritonitis, and mortality. Our aim was to evaluate the independent association of NOD2 variants with BI according to the decompensation stage.

Methods: Consecutive patients with cirrhosis in 2 academic medical centers were included and genotyped for the NOD2 variants p. Read More

BMJ Open 2019 Jan 29;9(1):e025664. Epub 2019 Jan 29.

Division of Medicine, University College London, London, UK.

Introduction: Use of albumin therapy is recommended for management of disease complications in cirrhosis. The effectiveness of albumin to prevent specific disease complications and death, however, is less clear.

Methods And Analysis: We will search Medline (Ovid), Embase (Ovid), Cochrane Hepato-Biliary Controlled Trials Register and Cochrane Central Register of Controlled Trials for published reports on randomised controlled trials and observational studies on the effectiveness of intravenous albumin therapy to prevent spontaneous bacterial peritonitis, renal dysfunction and death in cirrhotic patients. Read More

Eur J Gastroenterol Hepatol 2019 Jan 28. Epub 2019 Jan 28.

Departments of Tropical Medicine.

Background And Objective: Spontaneous bacterial peritonitis (SBP) is a common bacterial infection with life-threatening sequelae in cirrhotic ascites. The purpose of this retrospective cohort study was to recognize the predictors of SBP to build up a noninvasive system to exclude or establish an episode of SBP.

Patients And Methods: Of 1194 consecutive patients with cirrhotic ascites, only 966 patients were enrolled in this study. Read More

Am J Gastroenterol 2019 Apr;114(4):599-606

University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Objectives: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis.

Methods: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Read More

New Microbes New Infect 2019 Mar 18;28:1-5. Epub 2018 Dec 18.

)Department of Microbiology, University Hospital of Larissa, Larissa, Greece.

Spontaneous bacterial peritonitis (SBP) is often difficult to diagnose because bacteria in ascites cannot be detected accurately by conventional culture. In this study, we evaluated the use of broad-range 16S rRNA PCR, applied either directly to a total of 32 ascitic fluids (AFs) or to the AF vial cultures, after a long incubation of 14 days; the results were compared with those of AF vial cultures. was isolated in four of 32 AF vial cultures (12. Read More

Hepat Med 2019 14;11:13-22. Epub 2019 Jan 14.

Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,

Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Read More

Hepatol Int 2019 Jan 18;13(1):1-21. Epub 2019 Jan 18.

Department of Pathogen Biology, Peking University Health Science Center, Beijing, China.

The Chinese Society of Hepatology developed the current guidelines for the Management of Ascites and Its Related Complications in Cirrhosis based on the published evidences and the panelists' consensus. The guidelines provided recommendations for the diagnosis and management of cirrhotic ascites emphasizing a step-wise approach with the first-, second-, and third-line therapy. For refractory ascites, vasoconstrictors and albumin are recommended for splanchnic vasodilation and selective vasopressin (V2) receptor antagonists for moderate-to-severe hyponatremia. Read More

IDCases 2019 8;15:e00489. Epub 2019 Jan 8.

Pediatric Infectious Diseases Unit - Santa Casa de São Paulo, São Paulo, Brazil.

Spontaneous bacterial peritonitis is an uncommon manifestation of invasive pneumococcal disease and frequently occurs when an underlying hepatic disease is present. Bacterial identification through culture can be particularly challenging in patients with prior or concurrent antimicrobial use. DNA amplification detects very few copies of target DNA under ideal conditions in CSF or pleural effusion and, therefore, can be useful in selected infections. Read More

Transplant Proc 2019 Jan - Feb;51(1):41-43. Epub 2018 Jun 30.

Unit of Hepatobiliary Surgery and Liver Transplantation, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Maimónides de Investigación Biomédica de Córdoba, University Hospital Reina Sofía, Córdoba, Spain.

Background: Guidelines for the management of refractory ascites (RA) recommend transjugular intrahepatic portosystemic shunting (TIPS), diuretics, and paracentesis as the main strategies, discouraging use of surgical peritoneovenous shunts (PVSs). However, PVSs, including both Denver (DS) or saphenoperitoneal (SPS) modalities, may still have indications. Herein we report our experience with PVSs in the context of modern surgical and anesthetic management. Read More

Acta Gastroenterol Belg 2018 Oct-Dec;81(4):509-516

Department of Oncology, University of Health Sciences Antalya Training and Research Hospital, Antalya; Turkey.

Objective: To evaluate the utility of B-mode gray-scale histogram analysis in the management of patients with infected cirrhotic ascites.

Methods: A total of 97 patients (mean(SD) age : 66.8(14. Read More

J Clin Transl Hepatol 2018 Dec 18;6(4):372-376. Epub 2018 Jul 18.

Hepatology and Gastroenterology department, National Liver Institute, Menoufia University, Egypt.

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and a prognostic model to predict it is needed. This study was designed to test the ability of different laboratory tests and the new scoring system by Wehmeyer and colleagues (consisting of age, C-reactive protein (CRP) and platelet count) to predict it. Three-hundred patients admitted to the National Liver Institute, University of Menoufia, Egypt (2015-2016) with liver cirrhosis and ascites were included in our study. Read More

World J Hepatol 2018 Dec;10(12):892-897

Unidad de Hígado, Hospital Privado de Rosario, Rosario 2000, Argentina.

Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis (SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Read More

Clin Exp Hepatol 2018 Dec 3;4(4):247-252. Epub 2018 Dec 3.

Pediatric Department, Quesna Central Hospital, Ministry of Health, Menoufia, Egypt.

Aim Of The Study: We aimed to assess the utility and rapidity of granulocyte elastase (GE) latex immunoassay and leukocyte esterase (LE) reagent strips for the diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic children with ascites.

Material And Methods: This study included 80 ascitic fluid (AF) samples from 45 patients with chronic liver diseases. They were divided into 2 groups (SBP and non-SBP groups). Read More

Clin Exp Hepatol 2018 Dec 3;4(4):224-231. Epub 2018 Dec 3.

Department of Hepatology and Infectious Diseases, Wrocław Medical University, Poland.

Spontaneous bacterial peritonitis (SBP) is one of the most common bacterial infections in patients with liver cirrhosis and it significantly contributes to the deterioration of the prognosis and increased risk of mortality. Previous data suggested that the most common pathogens causing SBP are G-negative aerobic bacteria and treatment recommended by the international guidelines (EASL, AASLD) is highly effective. In recent years, due to the widespread use of antibiotic prophylaxis and the increased frequency of hospitalization along with the use of invasive procedures in patients with cirrhosis, the involvement of Gram-positive cocci and multi-drug resistant bacteria in the etiology of SBP is increasing. Read More

Ann Hepatol 2018 Oct;17(6):933-939

School of Medicine, Tzu Chi University, Hualien, Taiwan.

Introduction And Aim: Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with cirrhosis. However, it is unknown whether patients with SBP and cirrhosis who do not have active gastrointestinal bleeding have a poorer prognosis if treated with proton pump inhibitors (PPI).

Material And Methods: We used the Taiwan National Health Insurance Database to identify 858 patients with SBP and cirrhosis who were administered PPIs and hospitalized between January 1, 2010, and December 31, 2013. Read More

J Korean Med Sci 2018 Dec 7;33(52):e335. Epub 2018 Dec 7.

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

Background: Spontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients. Read More

Eur J Gastroenterol Hepatol 2019 04;31(4):540-546

Liver Unit.

Objective: Few studies carried out more than 20 years ago have evaluated spontaneous bacterial peritonitis (SBP) recurrence in patients receiving secondary antibiotic prophylaxis. These studies reported a 1-year recurrence rate of 20-26%. Changes in the bacteriology of SBP over the last few years might have negative effects on secondary prophylaxis. Read More

Clin Imaging 2019 Mar - Apr;54:71-77. Epub 2018 Nov 27.

Department of Radiology, Division of Vascular and Interventional Radiology, Columbia University Medical Center, 177 Fort Washington Ave, Milstein Hospital - 4 Hudson North, New York, NY 10032, United States of America.

Purpose: To report the effect of partial splenic embolization (PSE) on hematological indices and the procedure's safety in pre- and post-liver transplant (LT) patients.

Materials And Methods: A single-center retrospective study evaluating all patients who underwent PSE over a 16-year period was performed. Inclusion criteria were splenomegaly confirmed by imaging and at least one of the following cytopenias: hemoglobin ≤10 g/dL, WBC count ≤1500 μL, or platelet count ≤100,000 μL. Read More

Eur J Gastroenterol Hepatol 2019 05;31(5):626-632

Hepatology and Liver Transplant Unit, Department of Medical Area (DAME).

Objectives: Transjugular intrahepatic portosystemic shunt (TIPS) is adopted to treat refractory complications of portal hypertension, such as variceal bleeding and ascites. This study aimed to assess predictors of hepatic encephalopathy (HE) development and cumulative transplant-free survival after TIPS placement in patients with cirrhosis complicated by refractory ascites and major gastroesophageal bleeding.

Materials And Methods: Sixty-three cirrhotic patients who underwent TIPS positioning as a secondary prophylaxis of major upper gastroesophageal bleeding (N=30) or to control refractory ascites (N=33) were enrolled. Read More

Clin Res Hepatol Gastroenterol 2018 Oct 24. Epub 2018 Oct 24.

Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy. Electronic address:

Rev Recent Clin Trials 2018 Dec 3. Epub 2018 Dec 3.

Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, 80131, Naples. Italy.

Introduction: Historically, spontaneous bacterial peritonitis (SBP) has represented one of the most frequent and relevant infectious complications of advanced liver disease, and this is still valid today. Nevertheless, in recent years the role of fungi as causative pathogens of primary peritonitis in patients with cirrhosis has become not negligible. Another issue is linked with the traditional distinction, instrumental in therapeutic choice, between community-acquired and nosocomial forms, according to the onset. Read More

Semin Respir Crit Care Med 2018 Oct 28;39(5):578-587. Epub 2018 Nov 28.

Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Infections remain a leading cause of morbidity and mortality among patients with liver failure. A number of factors, including relative immune dysfunction and systemic inflammation, bacterial translocation, gut dysbiosis, small intestine bacterial overgrowth, altered bile acid pools, and changes in pH due to acid suppression, contribute to the high rates of infection in this population. Though a range of infections can complicate the course of cirrhotic patients, spontaneous bacterial peritonitis (SBP), cholangitis, and cholecystitis in addition to other infections (i. Read More

Semin Respir Crit Care Med 2018 Oct 28;39(5):566-577. Epub 2018 Nov 28.

Division of Gastroenterology and Hepatology, Center for Liver Diseases and Transplantation, Weill Cornell Medical College, New York, New York.

Gastrointestinal (GI) bleeding and ascites are two significant clinical events that frequently present in critically ill patients with chronic liver failure or decompensated cirrhosis. GI bleeding in patients with cirrhosis, particularly portal hypertensive-associated bleeding, carries a high short-term mortality (15-25%) and requires early initiation of a vasoactive agent and antibiotics as well as timely endoscopic management. Conservative transfusion strategies and adequate airway protection are also imperative to assist in bleeding control. Read More