Liver Cirrhosis Of Different Etiologies Research Articles

Hemoglobin and Endotoxin Levels Predict Sarcopenia Occurrence in Patients with Alcoholic Cirrhosis

Alcohol is a major risk factor of liver cirrhosis (LC). This study aimed to elucidate a surrogate marker of sarcopenia in patients with LC of different etiology. Out of 775 patients with LC, 451 were assessed for handgrip strength and skeletal muscle mass (by computed tomography). They were then divided into two groups: alcoholic cirrhosis (AC; n = 149) and nonalcoholic cirrhosis (NAC; n = 302). Endotoxin activity (EA) levels were measured with an EA assay. Group AC showed significantly higher platelet counts (p = 0.027) and lower blood urea nitrogen levels and fibrosis-4 index than group NAC (p = 0.0020 and p = 0.038, respectively). The risk factors of sarcopenia were age ≥ 65 years, female sex, CP-C LC, Hb levels < 12 g/dL, and EA level > 0.4 in all patients with LC; hemoglobin (Hb) levels < 12 g/dL and EA level > 0.4 in group AC; and age ≥ 65 years, CP-C LC, and Hb levels < 12 g/dL in group NAC. The prediction accuracy of Hb for sarcopenia in group AC, group NAC, and all patients was 83.6%, 75.9%, and 78.1% (sensitivity: 92.0%, 69.0%, and 80.2%; specificity: 66.4%, 71.0%, and 64.0%), respectively. Although not significant, the predictive performance was better when using the combination of Hb and EA measurements than when using Hb alone in group AC but was comparable in all patients. Hb levels can predict sarcopenia in patients with LC, but in those with AC, the combination of Hb and EA improves the prediction performance.

Relationship of phase angle and skeletal muscle index in patients with liver cirrhosis of different etiologies

Introduction. Sarcopenia is common among patients with liver cirrhosis (LC) and has a significant impact on the quality of life of patients, the nature of the course of the disease and mortality. The phase angle (PhA) is the arctangent of the ratio of reactive and active resistances for a variable frequency current obtained using bioimpedance analysis. Data on the relationship between PhA and sarcopenia are limited, so the analysis of this topic is the important step towards understanding the role of sarcopenia in LC.The objective was to evaluate the relationship between the values of the phase angle and the index of skeletal musculature obtained by CT volumetry in patients with LC.Methods and materials. The study included 15 patients diagnosed with LC. The anthropometric examination was carried out, followed by an assessment of the component composition of the patients’ body using the ABC-01 «Medass» device (STC Medass, Russia). According to the indications, all patients underwent CT of the abdominal cavity without contrast enhancement.Results. Median and interquartile interval PhA (°): 5.3 [4.2–5.7] in men and 5.2 [4.9–6.1] in women, skeletal muscle index (cm2/m2): 51.82 [48.33–53.75] cm2/m2 in men and 44.114 [38.9–49.32] cm2/m2 in women. The correlation analysis revealed a positive correlation of the average strength between the skeletal muscle index (cm2/m2) and PhA (°): r=0.2619, p-value=0.036845.Conclusion. Determination of the components of body composition and their relationship with the course of diseases in patients with LC may have practical application and requires further study.

Glutathione-S-transferases genes-promising predictors of hepatic dysfunction.

One of the most commonly known genes involved in chronic diffuse liver diseases pathogenesis are genes that encodes the synthesis of glutathione-S-transferase (GST), known as the second phase enzyme detoxification system that protects against endogenous oxidative stress and exogenous toxins, through catalisation of glutathione sulfuric groups conjugation and decontamination of lipid and deoxyribonucleic acid oxidation products. The group of GST enzymes consists of cytosolic, mitochondrial and microsomal fractions. Recently, eight classes of soluble cytoplasmic isoforms of GST enzymes are widely known: α-, ζ-, θ-, κ-, μ-, π-, σ-, and ω-. The GSTs gene family in the Human Gene Nomenclature Committee, online database recorded over 20 functional genes. The level of GSTs expression is considered to be a crucial factor in determining the sensitivity of cells to a broad spectrum of toxins. Nevertheless, human GSTs genes have multiple and frequent polymorphisms that include the complete absence of the GSTM1 or the GSTT1 gene. Current review supports the position that genetic polymorphism of GST genes is involved in the pathogenesis of various liver diseases, particularly non-alcoholic fatty liver disease, hepatitis and liver cirrhosis of different etiology and hepatocellular carcinoma. Certain GST allelic variants were proven to be associated with susceptibility to hepatological pathology, and correlations with the natural course of the diseases were subsequently postulated.

High prevalence of anti-HEV antibodies among patients with immunosuppression and hepatic disorders in eastern Poland.

IntroductionThe incidence of hepatitis E virus (HEV) infections in Poland is largely unknown. This study aimed to describe seroprevalence of markers of HEV infection among patients with immunodeficiency of diverse etiology and patients with advanced chronic liver diseases.Material and methodsFour hundred fifty patients were enrolled; among them, 180 persons were solid organ transplant recipients, 90 patients were HIV-infected and 180 persons had confirmed liver cirrhosis of different etiology. Serum anti-HEV-IgG, IgM antibodies and HEV-antigen were detected by ELISA (Wantai, China).ResultsIn the group of transplant recipients, serum anti-HEV-IgG antibodies were detected in 40.6%, IgM in 1.1% and HEV-Ag in 2.8% of subjects. In the HIV-infected population 37.7% had anti-HEV-IgG, 1.1% had anti-HEV-IgM and none had HEV-Ag. Among patients with advanced chronic liver diseases the highest prevalence of anti-HEV-IgG was recorded in alcohol-related liver cirrhosis (52.1%) (p = 0.049). In the population of all liver cirrhotics anti-HEV-IgG seroprevalence was 48.3%, anti-HEV-IgM seroprevalence was 5.0% and HEV-Ag seroprevalence was 1.7%. Older age and male gender were significant risk factors associated with increased anti-HEV-IgG prevalence, p = 0.0004 and p = 0.02, respectively.ConclusionsIn this large cohort a high seroprevalence of anti-HEV-IgG was detected in comparison to other European countries, with the highest rates in patients with alcoholic liver disease and in transplant recipients.

Serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex levels predict survival in patients with cirrhosis

Complications of chronic liver diseases – particularly hepatocellular carcinoma (HCC) – are a major cause of mortality worldwide. Several studies have shown that high or increasing levels of serum Squamous Cell Carcinoma Antigen-Immunoglobulin M complex (SCCA-IgM) are associated with development of HCC in patients with advanced liver disease and worse survival in patients with liver cancer. The aim of the present study was to assess, in patients with advanced liver disease, differences in long-term clinical outcomes in relation to baseline levels of serum SCCA-IgM. Ninety one consecutive outpatients with liver cirrhosis of different etiologies, without hepatocellular carcinoma at presentation, were enrolled from April 2007 to October 2012 in a prospective study. For a median time of 127 months, patients were bi-annually re-evaluated. SCCA-IgM complex levels were determined with a validated enzyme-linked immunosorbent assay. The results provided evidence that serum SCCA-IgM is a predictor of overall survival. The best cut-off to discriminate both HCC-free and overall survival rates was 120 AU/mL. Patients with baseline values higher than this threshold showed a substantial increase in both HCC incidence rate and all-cause mortality rate. In conclusion, a single measurement of serum SCCA-IgM helps to identify those patients with liver cirrhosis with increased risks of HCC development and mortality.

An Analysis of the Liver Transplant Waiting List at the G. G. Kuvatov Republican Clinical Hospital

Introduction. Liver transplantation is currently considered to be the only method of radical treatment for adults and children with incurable liver diseases. The most important aspects of liver transplantation are the correct selection of an appropriate recipient and compilation and maintenance of a liver transplant waiting list. This article aims to analyze the structure of the severe chronic liver disease patient population included in the liver transplant waiting list at the G. G. Kuvatov Republican Clinical Hospital (the City of Ufa). Materials and methods . We analyzed the waiting list drawn and maintained over the 2007-2018 period based on the examination of 789 patients with liver cirrhosis of various etiologies. Results and discussion . Out of all the patients with liver cirrhosis of different etiologies (Child-Pugh score classes A, B, and C) 149 (18.8 %) were included in the waiting list. The ages of patients included in the liver transplant waiting list ranged from 19 to 69. The mortality rate amounted to 38.9 % (58 people); of these patients 31 (53.4 %) had hepatic cirrhosis (HC) of autoimmune etiology, 18 (31.0 %) — HC of viral etiology, and 6 (10.3 %) — alveococcosis of the liver. The rate of the waiting list expansion for patients aged 20-29 compared to those aged 0-19 amounted to 1.32 %. Such a dynamics for the 30-39 age group compared to the 20-29 age group was 11.51 %. The number of people aged 40-49 compared to the preceding age group remained the same. Conclusion. Our analysis of the waiting list sets the percentage of patients with autoimmune HC in the population of patients with this disease at 59 %. These patients are characterized by a rapid progression of liver failure and high mortality. The statistical analysis of liver transplant waiting lists facilitate the optimization of procedures used to select and manage such patients, as well as to prevent, in a timely manner, the development of complications thus improving the prognosis of survival.

TM6SF2 and MBOAT7 Gene Variants in Liver Fibrosis and Cirrhosis

Previous large-scale genetic studies identified single nucleotide polymorphisms (SNPs) of the TM6SF2 and MBOAT7 genes as risk factors for alcoholic liver cirrhosis and non-alcoholic fatty liver disease. In this study, we tried to evaluate the association between TM6SF2 variant rs58542926 and MBOAT7 variant rs641738 and the risk of hepatic fibrosis or liver cirrhosis of different etiology. In parallel, we also aimed to evaluate whether these two SNPs modify the effects of the PNPLA3 rs738409 risk variant for the development of hepatic fibrosis and liver cirrhosis. The study was conducted at the Department of Gastroenterology, Lithuanian University of Health Sciences Hospital, and included 334 patients with liver cirrhosis, 128 patients with liver fibrosis, and 550 controls. SNPs were genotyped by quantitative PCR, using TaqMan allelic discrimination assays. Overall, TM6SF2 rs58542926 as well as MBOAT7 rs641738 were not linked to hepatic fibrosis, alcohol or hepatitis C virus induced liver cirrhosis in an Eastern European population. These genetic variations also did not mediate the effect of PNPLA3 rs738409 SNP for liver developing liver fibrosis or liver cirrhosis.

Liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging in primary biliary cholangitis patients.

To evaluate the feasibility of utilizing gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the assessment of Child-Pugh class and for differentiating between patients with primary biliary cholangitis (PBC) and posthepatitic cirrhosis. 45 PBC patients and 45 posthepatitic cirrhosis patients were enrolled and Gd-EOB-DTPA-enhanced MRI was applied. The average relative signal enhancement (RE) of the liver and average contrast to noise ratio (CNR) of common bile duct at 4, 20, and 50 min between different Child-Pugh classes of PBC patients were compared. The RE and CNR in all timepoints in patients with the same Child-Pugh class were compared between PBC patients and posthepatitic cirrhosis patients. The RE of liver and CNR of common bile duct at 4, 20, and 50min was significantly different between all Child-Pugh classes of PBC patients. There were also no significant differences in the RE of liver and CNR of common bile duct in all timepoints between patients with PBC and posthepatitic cirrhosis in the same Child-Pugh class. Gd-EOB-DTPA-enhanced MRI is feasible for liver function assessment in PBC patients. However, the ability of this modality in differentiating liver cirrhosis of different etiologies requires further investigation.

Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment.

BackgroundIt is well known that the incidence of developing hepatocelluler carcinoma (HCC) is increased in liver cirrhosis of different etiologies. However, comparison of HCC incidence in various liver diseases has not yet been estimated. We surveyed this comparison.MethodsThe PubMed database was examined (1989‐2017) for studies published in English language regarding the prospective follow‐up results for the development of HCC in various liver diseases. A meta‐analysis was performed for each liver disease.ResultsThe annual incidence (%) of HCC in the non‐cirrhotic stage and cirrhotic stage, and the ratio of HCC incidence in the cirrhotic stage/non‐cirrhotic stage were as follows. (a) hepatitis B virus liver disease: 0.37%→3.23% (8.73‐fold), (b) hepatitis C virus liver diseases: 0.68%→4.81% (7.07‐fold), (c) primary biliary cholangitis (0.26%→1.79%, 6.88‐fold), (d) autoimmune hepatitis (0.19%→0.53%, 2.79‐fold), and (e) NASH (0.03%→1.35%, 45.00‐fold). Regarding primary hemochromatosis and alcoholic liver diseases, only follow‐up studies in the cirrhotic stage were presented, 1.20% and 2.06%, respectively.ConclusionsWhen the liver diseases advance to cirrhosis, the incidence of HCC is markedly increased. The development of HCC must be closely monitored by ultrasonography, magnetic resonance imaging, and computed tomography, irrespective of the different kinds of liver diseases.

Prognostic value of lectin pathway molecules and complement proteins in ascitic fluid and blood in patients with liver cirrhosis

Background and aim: Patients with liver cirrhosis and ascites have a poor prognosis with increased risk of infection related death, as advanced stages of cirrhosis are associated with immunodeficiency. We aimed to investigate immunologically active molecules in ascitic fluid and blood and their potential association to survival.Materials and methods: In an exploratory pilot study; blood and ascitic fluid from 34 patients with liver cirrhosis of different etiology were analyzed for pattern recognition molecules (ficolin-1, ficolin-2, ficolin-3 and MBL) and complement proteins (C4 and C3). An observational follow-up study (minimum 17 months) was conducted to assess the association to all-cause mortality or liver transplantation.Results: Ficolin-1, ficolin-2, MBL, C4 and C3 in ascitic fluid and ficolin-1, C4 and C3 in blood were significantly (p = .001–.027) lower in patients with Child-Pugh stage C (n = 16, 47%) compared to Child-Pugh stage B cirrhosis (n = 18, 53%). In multivariate COX-regression analysis low levels of ficolin-1(p = .036) and C3 (p = .025) in ascitic fluid and C4(p = .005) and C3 (p = .032) in serum were associated with all-cause mortality or liver transplantation independent of Child-Pugh score.Conclusion: Levels of lectin-complement pathway molecules in ascitic fluid and blood are lower in patients with more advanced stage of cirrhosis. Low C4 and C3 in serum and C3 and ficolin-1 in ascitic fluid are risk factors for all-cause mortality or liver transplantation independently of liver function in patients with cirrhosis and ascites.

Ultrasound elastography of the liver for assessing the risk of complications of its cirrhosis of different etiologies

To study the results of dynamic liver ultrasound elastography (LUE) in assessing the risk of complications of liver cirrhosis (LC) of different etiologies and to elaborate a monitoring program for estimation of the predictive value of elastography in patients with LC. A total of 194 patients with LC of different etiologies, including 56 patients with alcoholic cirrhosis, 48 with LC and an outcome of nonalcoholic fatty liver disease, 53 with LC and an outcome of chronic hepatitis C, 23 with LC and an outcome of chronic hepatitis B, and 14 with an outcome of coinfection with hepatitis B and D viruses, were examined. An analysis was made between the presence of a number of LC complications and the results of LUE, by constructing the receiver operating characteristic (ROC) curves to select LUE threshold values, in which there was a high risk for LC complications (esophageal varices, bleeding esophageal varices, hepatic encephalopathy, and ascites). The investigation could obtain liver elastography threshold values expressed in kilopascals (kPa), which were proposed for use as a prognostic sign of the presence of complications caused by LC and assessed liver elastography threshold values for its mortality prediction. The predictive value of positive LUE results in determining the risk of different complications was 75.7 to 92.5%; that of negative results was 70 to 92.9%. An algorithm for individualized diagnostic and treatment policy was elaborated in relation to the liver elastography results obtained during the primary examination of a patient. The dynamic LUE findings in patients with LC of different etiologies suggest that the proposed LUE threshold values are efficient and may be used in practical healthcare, which will be able to timely correct management tactics for a patient and to monitor his treatment.

ДОСЛІДЖЕННЯ ЯКІСНИХ ОСОБЛИВОСТЕЙ ФАРМАЦЕВТИЧНОГО ЗАБЕЗПЕЧЕННЯ ХВОРИХ НА ЦИРОЗИ ПЕЧІНКИ ІЗ ВСТАНОВЛЕНИМИ УСКЛАДНЕННЯМИ ОСНОВНОГО ДІАГНОЗУ

<p>РЕЗЮМЕ. У статті наведено результати частотного аналізу листків призначень хворих на цирози печінки різної етіології. Вони вказують, що препарати, які були спожиті пацієнтами в умовах стаціонару, насамперед призначалися для лікування ускладнень основного діагнозу. Встановлено, що гепатоцелюлярна недостатність різного ступеня спостерігалася у 94 % пацієнтів, портальна гіпертензія – у 87,4 %, асцит – у 37,9 %. Тому найчастіше призначали: Верошпірон (Gedeon Richter Plc., Угорщина) – отримали 64,2 % пацієнтів, Тіогама Турбо (Woerwag Pharma GmbH & Co. KG, Німеччина) – 45,8 % та Дуфалак (Solvay Pharmaceuticals B.V., Нідерланди) – 41 % хворих.</p><p> </p><p>КЛЮЧОВІ СЛОВА: цирози печінки; ускладнення цирозу печінки; частотний аналіз; лікарські засоби, що застосовуються при захворюваннях печінки.</p>

Osteoporosis and FRAX risk in patients with liver cirrhosis

BackgroundHepatic osteodystrophy is any bone disease in patients with chronic liver disease. To measure bone mineral density (BMD) T-score by bone densitometry (BD) is used, classifying the disease in osteopenia, osteoporosis and severe osteoporosis. There are not criteria for monitoring and detection of osteodystrophy in cases of non-cholestasic cirrhosis. To determine the risk of fracture at 10 years, Fracture Risk Assessment Tool (FRAX), could be useful. ObjectivesDetermine the frequency of hepatic osteodystrophy in cirrhotic patients according to BD and FRAX and identify associated risk factors. Patients and methodsAn observational, analytic, cross-sectional study. We included cirrhotic patients with report of DO and FRAX. Results52 patients were included, 38 were female (73.1%). The mean age was 12.29±55.46 year-old, MELD 4.14±11.71. In cholestatic etiology Mayo Score was 2.9±3.31. The BMD was 0.756±0.1896mg/ cm 2 and T-score -2.34±1.0. Of all patients, 26 (50%) had ranges of osteopenia and 21 (40.4%) of osteoporosis. Fracture risk with FRAX 10-year was 7.77±6,713, and when we added the value of T-score fracture risk was 13.72±12. Higher prevalence of cholestatic diseases in women and viral etiology in men (P=0.006) was observed. There was significant relationship between cholestatic etiology T-score, alkaline phosphatase, and elderly and FRAXS with T-score (P=<0.05). Vitamin D was lower in patients with cholestatic liver disease (P=0.047) and a trend towards lower value of FRAX in patients with cholestatic liver disease was observed. ConclusionsThe frequency of osteoporosis or osteopenia is 90.4% in Mexican patients with liver cirrhosis of different etiologies. The decreased levels of bone alkaline phosphatase and 25-hydroxyvitamin-D were correlated with the risk of bone disease in patients with liver cirrhosis.

Serum prolactin in advanced chronic liver disease.

Hyperprolactinemia is a frequent endocrine disorder with well known harmful effects on the reproductive system and bone metabolism. Besides prolactinomas several drugs and disorders such as renal failure and hypothyroidism have been shown to cause hyperprolactinemia. Based on former studies, liver cirrhosis has also been suggested to cause hyperprolactinemia, while mechanisms have not been identified yet. In this study, we set out to investigate the prevalence and predictors of hyperprolactinemia in 178 patients with liver cirrhosis of different etio-logies. Eighteen out of 178 patients - 7 females and 11 males - displayed elevated serum pro-lactin levels. When patients were excluded who suffered from co-morbidities or took medication that are discussed to potentially interfere with prolactin metabolism, only 3 males displayed increased serum prolactin levels. Prolactin levels were similar in patients with liver cirrhosis of different etiologies. Our data suggest that hyperprolactinemia is not commonly found in patients with liver cirrhosis, but is mostly associated with intake of drugs or presence of comorbidites which are known to potentially cause hyperprolactinemia. We thus hypothesize that in contrast to former studies liver cirrhosis is not a common cause of hyperprolactinemia and that in the absence of co-morbidities or drugs that are known to potentially increase prolactin levels, marked hyperprolactinemia needs further investigation in patients with liver cirrhosis.

Analysis of serum haptoglobin fucosylation in hepatocellular carcinoma and liver cirrhosis of different etiologies.

We have developed herein a quantitative mass spectrometry-based approach to analyze the etiology-related alterations in fucosylation degree of serum haptoglobin in patients with liver cirrhosis and hepatocellular carcinoma (HCC). The three most common etiologies, including infection with hepatitis B virus (HBV), infection with hepatitis C virus (HCV), and heavy alcohol consumption (ALC), were investigated. Only 10 μL of serum was used in this assay in which haptoglobin was immunoprecipitated using a monoclonal antibody. The N-glycans of haptoglobin were released with PNGase F, desialylated, and permethylated prior to MALDI-QIT-TOF MS analysis. In total, N-glycan profiles derived from 104 individual patient samples were quantified (14 healthy controls, 40 cirrhosis, and 50 HCCs). A unique pattern of bifucosylated tetra-antennary glycan, with both core and antennary fucosylation, was identified in HCC patients. Quantitative analysis indicated that the increased fucosylation degree was highly associated with HBV- and ALC-related HCC patients compared to that of the corresponding cirrhosis patients. Notably, the bifucosylation degree was distinctly increased in HCC patients versus that in cirrhosis of all etiologies. The elevated bifucosylation degree of haptoglobin can discriminate early stage HCC patients from cirrhosis in each etiologic category, which may be used to provide a potential marker for early detection and to predict HCC in patients with cirrhosis.

Serum prolactin in advanced chronic liver disease

Hyperprolactinemia is a frequent endocrine disorder with well known harmful effects on the reproductive system and bone metabolism. Besides prolactinomas several drugs and disorders such as renal failure and hypothyroidism have been shown to cause hyperprolactinemia. Based on former studies, liver cirrhosis has also been suggested to cause hyperprolactinemia, while mechanisms have not been identified yet. In this study, we set out to investigate the prevalence and predictors of hyperprolactinemia in 178 patients with liver cirrhosis of different etio­logies. Eighteen out of 178 patients – 7 females and 11 males – displayed elevated serum pro­lactin levels. When patients were excluded who suffered from co-morbidities or took medication that are discussed to potentially interfere with prolactin metabolism, only 3 males displayed increased serum prolactin levels. Prolactin levels were similar in patients with liver cirrhosis of different etiologies. Our data suggest that hyperprolactinemia is not commonly found in patients with liver cirrhosis, but is mostly associated with intake of drugs or presence of comorbidites which are known to potentially cause hyperprolactinemia. We thus hypothesize that in contrast to former studies liver cirrhosis is not a common cause of hyperprolactinemia and that in the absence of co-morbidities or drugs that are known to potentially increase prolactin levels, marked hyperprolactinemia needs further investigation in patients with liver cirrhosis.

Portal Hypertensive Enteropathy, Occult Bleeding, and Capsule Endoscopy: Where Do We Go from Here?

Portal hypertension (PH) has many complications, some life-threatening. Historically, esophageal (EV) and gastric varices (GV), portal hypertensive gastropathy (PHG), and ascites were associated with PH [1]. Until just over a decade ago, the endoscopic examination of the small intestine was limited by its length. At the dawn of the millennium, deep enteroscopy (wireless or device-assisted) has been advanced by the advent of double-balloon technique and wireless capsule endoscopy (CE) [2, 3]. Since then, deep enteroscopy has identified portal hypertensive enteropathy (PHE) as a potentially significant complication of PH [4]. Due to its inherent advantages, CE has the latter has become the preferred method for PHE detection, particularly in the West [2]. Patients with advanced liver disease run an increased risk of gastrointestinal (GI) bleeding. In cirrhotic patients with chronic GI blood loss, with no obvious bleeding source visualized with bidirectional digestive endoscopy, PHE should be considered [5]. Nevertheless, whether it is necessary to routinely perform pan-enteroscopy in patients with PH with no evidence of obscure gastrointestinal bleeding (OGIB) is still a matter of continuing clinical research [6]. Documentation of PHE with small bowel CE is becoming more frequent [4, 5]. A consensus has emerged with regard to the type and distribution of small intestine mucosal abnormalities that constitute PHE [4, 5, 7]. The characteristic lesions of PHE include red spots indicative of arteriovenous malformations, patchy mucosal erythema, diffuse mucosal edema (so-called ‘herring-roe’ appearance), varices, and spontaneous mucosal bleeding [8, 9]. However, the prevalence of PHE ranges between 20 and 90 % [4, 5]. Furthermore, only a few studies have considered other clinical factors associated with the presence of PHE with conflicting results. In 2005, De Palma et al. were one of the first groups to use CE to study the type and prevalence of PH-related small intestinal lesions in a group of patients with liver cirrhosis of different etiologies, complicated by PH and anemia. In comparison with a control population diagnosed with irritable bowel syndrome, they essentially redefined PHE in the era of CE, reporting that large esophageal varices, PHG, portal hypertensive colopathy (PHC), and severe liver disease (Child–Pugh class C) are associated with the presence of PHE [7]. Conversely, the etiology of liver cirrhosis, patient gender, and history of EV hemorrhage were not associated with the presence of PHE. More recently, another landmark study by Abdelaal et al. [10] reported that CE findings consistent with PHE were present in 67.7 % of patients with liver cirrhosis. They were more common in patients with high liver stiffness as measured by FibroScan, higher Child–Pugh score, large EVs, PHG, and a history of endoscopic EV sclerotherapy or band ligation. Furthermore, they refined the currently used classification of PHE CE findings into four main types: (1) red spots; (2) angiectasia; (3) small intestinal varices; and (4) inflammatory-like lesions [4, 8–10]. More importantly, however, Abdelaal et al. introduced the concept of combining auxiliary data such as transient elastography with more conventional clinical data in an attempt to select a patient population in risk for PHE. Takahashi et al. [11] reported that in CE, mucosal edema, unlike red spots and angiectasia, correlated well with the hepatic venous pressure gradient (HVPG). The latter had no significant K. J. Dabos ! A. Koulaouzidis (&) Endoscopy Unit, Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK e-mail: akoulaouzidis@hotmail.com

Bacterial infections in patients with liver cirrhosis and ascites

Bacterial infections are common complications and the cause of death in patients with cirrhosis and ascites. There is no standard method for a rapid and low-cost diagnosis, and its prognosis is poor. The aim of this study was to determine the etiology and frequency of bacterial infections in patients with liver cirrhosis of different etiology, and the influence of bacterial infections on the prognosis in patients with liver cirrhosis and ascites. Sixty-four patients with cirrhosis and ascites were included in the study. The diagnosis of spontaneous bacterial peritonitis was established based on the diagnostic abdominal paracentesis and the results of biochemical, cytological and microbiologic analysis of ascitic fluid. The diagnosis of urinary infection and pneumonia were made according to the standard criteria. Spontaneous bacterial peritonitis was diagnosed in 23 (35.9%) patients, urinary infections in 16(25%) and pneumonia in 11 (17.2%). Gram positive and gram negative bacteria in spontaneous bacterial peritonitis were etiologically almost equally represented (52%; 48%).The most frequent causes were Escherichia coli and Staphylococcus aureus. In 81% of patients urinary infections were caused by gram negative bacteria (Escherichia coli in 44%). The most frequent cause of pneumonia was Streptococcus pneumoniae (46%). Spontaneous bacterial peritonitis, urinary infections and bronchopneumonia are the most frequent bacterial infections in patients with liver cirrhosis and ascites. A timely recognition of bacterial infections and the initiation of treatment have a positive effect on the prognosis of such patients.

Rapid "breath-print" of liver cirrhosis by proton transfer reaction time-of-flight mass spectrometry. A pilot study.

The aim of the present work was to test the potential of Proton Transfer Reaction Time-of-Flight Mass Spectrometry (PTR-ToF-MS) in the diagnosis of liver cirrhosis and the assessment of disease severity by direct analysis of exhaled breath. Twenty-six volunteers have been enrolled in this study: 12 patients (M/F 8/4, mean age 70.5 years, min-max 42–80 years) with liver cirrhosis of different etiologies and at different severity of disease and 14 healthy subjects (M/F 5/9, mean age 52.3 years, min-max 35–77 years). Real time breath analysis was performed on fasting subjects using a buffered end-tidal on-line sampler directly coupled to a PTR-ToF-MS. Twelve volatile organic compounds (VOCs) resulted significantly differently in cirrhotic patients (CP) compared to healthy controls (CTRL): four ketones (2-butanone, 2- or 3- pentanone, C8-ketone, C9-ketone), two terpenes (monoterpene, monoterpene related), four sulphur or nitrogen compounds (sulfoxide-compound, S-compound, NS-compound, N-compound) and two alcohols (heptadienol, methanol). Seven VOCs (2-butanone, C8-ketone, a monoterpene, 2,4-heptadienol and three compounds containing N, S or NS) resulted significantly differently in compensate cirrhotic patients (Child-Pugh A; CP-A) and decompensated cirrhotic subjects (Child-Pugh B+C; CP-B+C). ROC (Receiver Operating Characteristic) analysis was performed considering three contrast groups: CP vs CTRL, CP-A vs CTRL and CP-A vs CP-B+C. In these comparisons monoterpene and N-compound showed the best diagnostic performance.ConclusionsBreath analysis by PTR-ToF-MS was able to distinguish cirrhotic patients from healthy subjects and to discriminate those with well compensated liver disease from those at more advanced severity stage. A breath-print of liver cirrhosis was assessed for the first time.

Acoustic Radiation Force Elastography and Transient Elastography in Cystic Fibrosis: Liver Stiffness Is not increased in CF-Related Liver Disease in Adults

Patients with cystic fibrosis (CF) can develop cholestatic liver disease (CFLD). We evaluated ARFI, transient elastography (TE), and APRI-score in adult CF-patients for detection of CFLD. CFLD was defined by ≥2 of the criteria: hepatomegaly, abnormal findings in conventional sonography and elevated liver enzymes. 50 healthy controls and 40 patients with liver cirrhosis of different etiologies served as ARFI controls. ARFI and TE were performed in the right liver lobe. 55 CF patients were recruited (30 males, 25 females, age 30.3 years; n = 41 without CFLD, n = 14 with CLFD). CFLD-individuals (mean 1.16 m/s; 95% CI [0.93; 1.39]) showed an ARFI shear-wave velocity similar to CF-patients without liver involvement (mean 1.13 m/s; 95% CI [1.08; 1.17]). Both subgroups did not differ from healthy controls (mean 1.15 m/s; 95%CI [1.10; 1.20]). CF cases with liver cirrhosis (n = 6; mean 1.49 m/s) differed significantly from cirrhosis of other etiologies (mean 3.07 m/s; p<0.001). TE revealed a liver stiffness of 5.34 kPa (95% CI [3.34; 7.35]) in CFLD versus 3.98 kPa (95% CI [3.63; 4.33]) in non-CLFD cases (p = 0.002). Diagnostic performance for CFLD detection was comparable between ARFI (AUROC 0.885±0.09), TE (AUROC 0.895±0.09) and APRI-score (AUROC 0.93±0.07). Liver stiffness is not increased in CFLD. Diagnostic accuracy of ARFI and TE in CF is limited. Tissue stiffness depends on the etiology of liver disease.