Fibroscan® and Shear Wave correlated well in hepatic fibrosis evaluation of patients with chronic liver diseases "in real life situation"

Prevalence of hepatic steatosis and fibrosis in Turner syndrome: A prospective case-control study

BACKGROUND AND AIMS

Abnormal liver chemistries are common in Turner syndrome (TS). Guidelines suggest that TS patients undergo annual screening of liver enzymes, but the role of non-invasive screening for steatosis and fibrosis is not clearly defined. We compared the prevalence of hepatic steatosis and fibrosis among TS patients to healthy controls using ultrasound with shear-wave elastography (SWE) and assessed for risk factors associated with steatosis and fibrosis in TS.

METHODS

Prospective case-control study of TS versus control patients from 2019 to 2021. All patients underwent abdominal ultrasound with doppler and SWE to assess hepatic fibrosis and steatosis. Risk factors were compared between TS and controls, as well as within the TS group.

RESULTS

A total of 55 TS and 50 control patients were included. Mean age was 23.6 years vs. 24.6 years in the control group (p = .75). TS patients had significantly more steatosis (65% vs. 12%, stage 1 vs. 0, p < .0001) and fibrosis (39% vs. 2%, average Metavir F2 vs. F0, p < .00001) than controls. These findings remained significant after adjusting for body mass index (BMI) (p < .01). GGT is more sensitive than AST or ALT in identifying these changes.

CONCLUSION

TS is associated with an increased prevalence of hepatic steatosis and fibrosis compared to healthy controls. Our findings suggest that serum GGT and ultrasound with SWE may help identify TS patients with liver disease. Early risk factor mitigation including timely oestrogen replacement, weight control, normalization of lipids and promoting multidisciplinary collaboration should be encouraged.

Frequency of fibrosis in patients with incidentally detected hepatosteatosis

OBJECTIVE

In this study, we aimed to elucidate fibrosis in patients who visited our outpatient clinic with complaints such as abdominal pain and dyspepsia and who had fatty liver by ultrasound imaging.

METHODS

A total of 119 patients who were admitted to the gastroenterology outpatient clinic of our institution with incidentally detected hepatosteatosis on ultrasound imaging were included in the study. Patients with hepatosteatosis were examined for fibrosis with the FibroScan-502-touch (Echosens, Paris, France) elastic tissue ultrasonography device. The effects of these parameters on hepatosteatosis and possible fibrosis degree were investigated.

RESULTS

No fibrosis was detected in 75 (63.02%) patients with hepatosteatosis on ultrasound imaging, 20 (10.05%) F1, 22 (18.48%) F2, 1 (0.8%) F3, and 0.1 (0.8%) F4. Accordingly, as the degree of steatosis increases in patients with incidentally detected hepatosteatosis, the degree and frequency of fibrosis increase with statistical significance (p<0.05). A statistically significant difference was found between the alanine transaminase increase and the hepatosteatosis degree (p=0.028). The median value of gamma-glutamyltransferase was 15 U/L in S0, 18.5 U/L in S1, 22 U/L in S2, and 26 U/L in S3 (p<0.047).

CONCLUSION

To date, no research exists on fibrosis in patients with incidental hepatosteatosis. The outcomes of this study elaborated that patients with hepatosteatosis in the community could be detected at least at an early stage by following up and diagnosing them with serum markers before they progress to end-stage fibrosis.

Thyroid Hormone Receptor-β Agonists in NAFLD Therapy: Possibilities and Challenges

Nonalcoholic fatty liver disease (NAFLD) is a progressive metabolic liver disease with an unknown pathogenesis and no FDA-approved drug treatment to date. Hypothyroidism has been identified as a risk factor for NAFLD as thyroxine is required for regulating metabolism in adults. Thyroxine has been shown to reduce fat in the livers of murine models with experimentally induced NAFLD. The use of synthetic thyroxine has been shown to increase lipid metabolism leading to weight loss; however, thyroxine has also been shown to cause many side effects, especially in the heart. Overcoming these cardiac side effects involves designing agonists specific to one of the 2 gene subtypes for the thyroid hormone (TH) receptor (TR), TRβ. While the other TH receptor subtype, TRα, is mainly expressed in the heart and is responsible for thyroxine's cardiac function, TRβ is mainly expressed in the liver and is involved in liver function. Using TRβ-specific agonists to treat NAFLD can prevent cardiac and other adverse side effects. Several TRβ-specific agonists have shown positive therapeutic effects in NAFLD animal models and have entered clinical trials. We seek to provide a comprehensive updated reference of TRβ-specific agonists in this review and explore the future therapeutic potential of TRβ-specific activation in the treatment of NAFLD.