1
|
Vidal-Cevallos P, Flores-García N, Chávez-Tapia NC, Chalasani NP. Occult liver disease: A multinational perspective. Ann Hepatol 2024; 29:101480. [PMID: 38354950 DOI: 10.1016/j.aohep.2024.101480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Occult liver disease refers to the presence of unrecognized chronic liver disease and cirrhosis. Liver disease is currently the eleventh cause of death globally, representing 4% of all deaths in the world. Alcohol consumption is the leading cause of cirrhosis globally, accounting for approximately 60% of cases. The estimated global prevalence of non-alcoholic fatty liver disease (NAFLD) is 32.4% and has been steadily increasing over the last years. Viral hepatitis B and C accounted for 1.3 million deaths in 2020. Several studies in populations at high risk of chronic liver disease (elevated liver enzymes, type 2 diabetes, excessive alcohol consumption) have found an elevated prevalence of occult liver disease. Attempts should be made to assess the prevalence of occult liver disease in Latin America, a region with one of the highest rates of metabolic diseases and excessive alcohol consumption. Screening for NAFLD in high-risk subjects and screening for excessive drinking and alcohol use disorders at every level of medical care is relevant. Efforts should also focus on the early treatment of occult liver disease to try to reduce liver disease burden and, in the case of occult viral hepatitis infection, prevent further spreading.
Collapse
Affiliation(s)
- Paulina Vidal-Cevallos
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico
| | - Nayelli Flores-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Norberto C Chávez-Tapia
- Obesity and Digestive Disease Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Toriello Guerra, 14050, Mexico City, Mexico.
| | - Naga P Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States.
| |
Collapse
|
2
|
Ivashkin VT, Chulanov VP, Mamonova NA, Maevskaya MV, Zharkova MS, Tikhonov IN, Bogomolov PO, Volchkova EV, Dmitriev AS, Znojko OO, Klimova EA, Kozlov KV, Kravchenko IE, Malinnikova EY, Maslennikov RV, Mikhailov MI, Novak KE, Nikitin IG, Syutkin VE, Esaulenko EV, Sheptulin AA, Shirokova EN, Yushchuk ND. Clinical Practice Guidelines of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the National Scientific Society of Infectious Disease Specialists for the Diagnosis and Treatment of Chronic Hepatitis C. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2023; 33:84-124. [DOI: 10.22416/1382-4376-2023-33-1-84-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Аim:diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.Summary.Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.Conclusion.Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation.
Collapse
Affiliation(s)
- V. T. Ivashkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V. P. Chulanov
- Center for Epidemiologically Significant Infectious Diseases, National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - N. A. Mamonova
- Center for Epidemiologically Significant Infectious Diseases, National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - M. V. Maevskaya
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M. S. Zharkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I. N. Tikhonov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - P. O. Bogomolov
- M.F. Vladimirsky Moscow Regional Research Clinical Institute
| | - E. V. Volchkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Dmitriev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O. O. Znojko
- Moscow State University of Medicine and Dentistry
| | | | | | | | - E. Yu. Malinnikova
- Department of Virology, Russian Medical Academy of Continuing Professional Education
| | - R. V. Maslennikov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - M. I. Mikhailov
- North-Western State Medical University named after I.I. Mechnikov
| | | | | | - V. E. Syutkin
- Sklifosovsky Clinical and Research Institute for Emergency Medicine; Russian State Research Center — Burnazyan Federal Medical Biophysical Center
| | | | - A. A. Sheptulin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E. N. Shirokova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | |
Collapse
|
3
|
Hernandez-Tejero M, Clemente-Sanchez A, Bataller R. Spectrum, Screening, and Diagnosis of Alcohol-related Liver Disease. J Clin Exp Hepatol 2023; 13:75-87. [PMID: 36647416 PMCID: PMC9840079 DOI: 10.1016/j.jceh.2022.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Alcohol-related liver disease (ALD) represents one of the leading causes of chronic liver disease and is a major cause of liver-related deaths worldwide. ALD encompasses a range of disorders including simple steatosis, alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Patients with underlying ALD and continued heavy alcohol consumption can also develop an episode of acute-on-chronic liver injury called alcohol-associated hepatitis, the most severe form of the disease, which portends a poor prognosis. The most important risk factor for the development of ALD is the amount of alcohol consumed. Individual susceptibility to progression to advanced fibrosis among heavy drinkers is likely determined by a combination of behavioral, environmental, genetic, and epigenetic factors, but the mechanisms are largely unknown. The only effective therapy for ALD is prolonged alcohol abstinence. Diagnosis of ALD involves assessing patients for alcohol use disorder and signs of advanced liver disease. In clinical practice, the histological assessment for ALD diagnosis is uncommon, and it is usually based on the medical history, clinical manifestations, and laboratory and imaging tests. Several promising biomarkers that can have both diagnostic and prognostic value in patients with ALD have been identified in recent years. This review provides an overview of the clinical spectrum of ALD, the diagnostic approach of the disease from different perspectives as well as current diagnostic and prognostic biomarkers.
Collapse
Key Words
- AH, alcohol-associated hepatitis
- ALD, alcohol-related liver disease
- ASH, alcoholic steatohepatitis
- AST, aspartate aminotransferase
- AUD, alcohol use disorder
- AUDIT, Alcohol Use Disorders Identification Test
- CAGE, Cut down, Annoyed, Guilty, and Eye-opener
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders Fifth edition
- GGT, gamma-glutamyl transferase
- HCC, hepatocellular carcinoma
- INR, international normalized ratio
- LSM, liver stiffness measurement
- NAFLD, non-alcoholic fatty liver disease
- PCF, pericellular fibrosis
- SFS, SALVE fibrosis stages
- SHG, SALVE Histopathology Group
- TE, transient elastography
- WHO, World Health Organization
- alcohol-associated hepatitis
- alcohol-related liver cirrhosis
- alcohol-related liver disease
- alcoholic steatohepatitis
Collapse
Affiliation(s)
- Maria Hernandez-Tejero
- Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Ana Clemente-Sanchez
- Liver Unit, Digestive Department, Hospital General Universitario Gregorio Marañón, Complutense University of Madrid, CIBERehd, Madrid, Spain
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - Ramon Bataller
- Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA
| |
Collapse
|
4
|
Metformin-Associated Lactic Acidosis in a Diabetic Patient with Normal Kidney Function and Occult Cirrhosis. Case Rep Crit Care 2022; 2022:5506744. [PMID: 36247416 PMCID: PMC9556255 DOI: 10.1155/2022/5506744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background Lactic acidosis is a well-known complication of metformin accumulation in diabetic patients with kidney failure. However, it is not usual to raise the diagnosis of metformin-associated lactic acidosis when patients have normal kidney function. The causes of metformin-induced high lactate include the accumulation of normal doses of metformin in chronic kidney disease, an overdose of this drug without kidney failure, or an increase in lactate production due to the inhibition of liver gluconeogenesis. Case Presentation. We report the case of a 61-year-old diabetic man who was brought to the emergency room in a comatose state. His family reported abdominal pain with diarrhea in the last two days. He was found to have severe lactic acidosis with normal serum creatinine. He was on a regular dose of metformin, and his family denied any other medical history or any alcohol abuse. He showed no signs of infection, his liver enzymes were slightly elevated, and he had severe anemia. His hemodynamics deteriorated quickly within hours, and an abdominal computed tomography scan revealed no abnormalities. He underwent a laparotomy that ruled out mesenteric ischemia and revealed an abnormal liver. The liver biopsy later confirmed the diagnosis of cirrhosis. Conclusions We discuss here the probable causes of severe lactic acidosis and the role of metformin in exacerbating this acid-base disturbance in cirrhotic patients. Future research is needed to determine whether these patients might benefit from dialysis.
Collapse
|
5
|
Benmassaoud A, Nitulescu R, Pembroke T, Halme AS, Ghali P, Deschenes M, Wong P, Klein MB, Sebastiani G. Liver-related Events in Human Immunodeficiency Virus-infected Persons With Occult Cirrhosis. Clin Infect Dis 2020; 69:1422-1430. [PMID: 30561558 DOI: 10.1093/cid/ciy1082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected patients are at increased risk of liver-related mortality. The effect of occult cirrhosis (OcC), defined as preclinical compensated cirrhosis without any clinical findings, on liver-related events is unknown. METHODS HIV-infected patients from 2 Canadian cohorts underwent transient elastography (TE) examination and were classified as (1) OcC (TE ≥13 kPa with no sign of cirrhosis, including absence of thrombocytopenia and signs of advanced liver disease on ultrasound or gastroscopy); (2) overt cirrhosis (OvC) (TE ≥13 kPa with signs of cirrhosis); or (3) noncirrhotic patients (TE <13 kPa). Incidence and risk factors of liver-related events were investigated through Kaplan-Meier and Cox regression analyses, respectively. We estimated monitoring rates according to screening guidelines for hepatocellular carcinoma (HCC) by OcC and OvC status. RESULTS A total of 1092 HIV-infected patients (51% coinfected with hepatitis C virus) were included. Prevalence of OcC and OvC at baseline was 2.7% and 10.7%, respectively. During a median follow-up of 1.8 (interquartile range, 1.5-2.8) years, the incidence of liver-related events in noncirrhosis, OcC, and OvC was 3.4 (95% confidence interval [CI], 1.2-7.3), 34.0 (95% CI, 6.0-104.0), and 37.0 (95% CI, 17.0-69.1) per 1000 person-years, respectively. Baseline OcC (adjusted hazard ratio [aHR], 7.1 [95% CI, 1.3-38.0]) and OvC (aHR, 8.5 [95% CI, 2.8-26.0]) were independently associated with liver-related events. Monitoring rates for HCC were lower in patients with OcC (24%) compared to those with OvC (40%). CONCLUSIONS HIV-infected patients with OcC have a high incidence of liver-related events. Greater surveillance and earlier recognition with appropriate screening strategies are necessary for improved outcomes.
Collapse
Affiliation(s)
- Amine Benmassaoud
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital
| | - Roy Nitulescu
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Thomas Pembroke
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital.,Department of Infection and Immunity, Cardiff University, United Kingdom
| | - Alex S Halme
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital
| | - Peter Ghali
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital
| | - Marc Deschenes
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital
| | - Philip Wong
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, Royal Victoria Hospital.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
| |
Collapse
|
6
|
Chapman T, Dubinsky T, Barr RG. Ultrasound Elastography of the Liver: What the Clinician Needs to Know. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1293-1304. [PMID: 28258611 DOI: 10.7863/ultra.16.08001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Todd Chapman
- University of Washington Medical Center, Seattle, Washington, USA
| | | | - Richard G Barr
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Radiology Consultants, Youngstown, Ohio, USA
| |
Collapse
|
7
|
The Role of Real Time Elastography in the Diagnosis of a Patient with Liver Cirrhosis and Carcinoma of the Uncinate Process of the Pancreas - Case Study. CURRENT HEALTH SCIENCES JOURNAL 2015; 41:264-268. [PMID: 30538828 PMCID: PMC6246986 DOI: 10.12865/chsj.41.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/29/2022]
Abstract
ABSTRACT: Hepatic cirrhosis represents the most advanced stage of any chronic liver disease characterized by progressive fibrosis. We report the case of a patient with carcinoma of the uncinate process of the pancreas and an occult form of liver cirrhosis. We concluded, based on the bioclinical profile, that the jaundice syndrome had an underlying mixed mechanism, obstructive and hepatic. Although, the clinical suspicion of pancreatic cancer was backed up by ultrasound, computed tomography and magnetic resonance imaging, we did not obtain, through these imaging investigations, any indicative features of liver cirrhosis. In order to further evaluate the presence of liver cirrhosis, we assessed liver stiffness using two non-invasive methods: Transient Elastography and Real Time Tissue Elastography (RTE). We observed highly suggestive features of liver cirrhosis only through RTE, although its diagnostic accuracy still needs large validation studies. Intraoperative assessment confirmed the diagnosis of liver cirrhosis, changing also the type of surgical approach and patient prognosis.
Collapse
|
8
|
Noninvasive diagnosis of liver fibrosis: The importance of being reimbursed. Can J Gastroenterol Hepatol 2015; 29:219-20. [PMID: 25965444 PMCID: PMC4444033 DOI: 10.1155/2015/943410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|