Liver Disease In Adult Patients Research Articles

The Prospect of Non-Alcoholic Fatty Liver Disease in Adult Patients with Metabolic Syndrome: A Systematic Review.

In recent years, there has been an increasing trend in the development of non-alcoholic fatty liver disease (NAFLD) due to lifestyle changes. The limited treatment option for the disease makes it challenging to manage. This study aims to summarize the relationship between NAFLD and metabolic syndrome (MetS) and to give a clear idea of the risk factors in this systematic research. The five databases screened were PubMed, Google Scholar, Science Direct, and BMC using keywords and Medical Subject Heading (Mesh) combinations. The keywords used are "Metabolic Syndrome,""Syndrome X,""Insulin Resistance,""Obesity,""Type 2 Diabetes,"and "Dyslipidemia."Articles underwent a detailed process of screening and quality appraisal. Using the English language as a primary filtering parameter, papers over the last 13 years, dating from 2010 to 2023, are the basis of this review. We reviewed all possible human studies documenting NAFLD with a component of MetS. A total of1106 papers were identified. After duplicate removal, 995 articles underwent a rigorous review, and35 articles were chosen for quality appraisal.A total of 15 articles are part of this systematic review.This systematic review strongly concludes that NAFLD predominates in MetS patients. The pathophysiology and insulin resistance that is shared by the two conditionsas well as the fact that obesity is at the center of both is the connecting factor in this. Besides various demographic and risk factors, physical activity and diet also play a role in the development of NAFLD. Consequently, more studies on this relevant topic are needed.

The time has come to look for metabolic dysfunction‐associated fatty liver disease in adult patients with type 1 Gaucher disease

MAFLD encompasses a broad spectrum of histological lesions spanning steatosis, ballooning and inflammation with/without fibrosis. We agree that steatosis with necro-inflammation, featuring steatohepatitis, more likely progresses to clinically significant liver fibrosis than histological "simple" steatosis. However, according to current guidelines, the screening approach for MAFLD in at-risk populations and the diagnostic work-up in patients with suspected MAFLD should start with non-invasive evaluation of steatosis, followed by non-invasive assessment of fibrosis.

Effects of Probiotics on Intestinal Failure-Associated Liver Disease in Adult Patients Receiving Prolonged Parenteral Support: A Tertiary Care Center Experience.

It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure-associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving parenteral support, namely home parenteral nutrition (HPN) and home intravenous fluids (HIVFs). We retrospectively reviewed charts of patients with intestinal failure who received HPN or HIVF for >2 weeks at our tertiary center between January 2005 and August 2016. We excluded patients <18 years of age, patients with other causes of liver disease, patients who used probiotics for <30 days, patients with <6 months' follow-up, and those who had long-term antibiotic use (>30 days). Bivariable and multivariable logistic regression analyses were used in this study. A total of 282 patients who received parenteral support were included. Eighty-five percent of our sample received PN. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotics was 35.9% vs 54.4% in patients who did not use probiotics, P = .005. In multivariable analysis, only small-bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, odds ratio (OR) = 4.394 (95% confidence interval [CI], 1.635-11.814; P = .003) and OR = 4.502 (95% CI 1.412-14.351; P = .011), respectively. Our study revealed that the prevalence of IFALD was comparable among the probiotic users and nonusers. Only small bowel length of 1090 cm and HPN use showed a significant impact on IFALD.

950 Effects of Probiotics on Intestinal Failure-Associated Liver Disease in Adult Patients Receiving Prolonged Parenteral Support: A Tertiary Care Center Experience

INTRODUCTION: It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure-associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving prolonged parenteral support, namely home parenteral nutrition (HPN) and intravenous fluids (HIVF). METHODS: We identified a cohort of patients with intestinal failure (IF) who received HPN or HIVF for &gt;2 weeks at our tertiary center between January 2005 and August 2016. (Table 1) We excluded patients &lt; 18 years of age, patients with other causes of liver disease, patients who used probiotics for &lt; 30 days, patients with &lt; 6 months follow up and those who had long-term antibiotic use ( &gt;30 days). Bivariable and multivariable logistic regression analyses were used in this study. RESULTS: A total of 282 patients who received prolonged parenteral support were included. Eighty-five percent of our sample received PN, while the remaining got HIVF. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotic was 35.9% vs. 54.4% in patients who did not use probiotics, P = 0.005. In multivariable analysis, only small bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, OR = 4.114 (95% CI = 1.557-10.874, P = 0.004), OR = 4.164 (95% CI = 1.325-13.087, P = 0.015) respectively (Table 2). CONCLUSION: Our data does not support the use of probiotics to prevent IFALD in patients receiving prolonged parenteral support. Only small bowel length of 10-90 cm and prolonged HPN use showed a significant impact on IFALD.

Intestinal failure-associated liver disease in adult patients.

The aim of this review is to give up-to-date information on intestinal failure-associated liver disease (IFALD) and how its investigation and management has evolved. Despite advances in treatment for patients with intestinal failure, IFALD remains a significant cause of mortality. Liver biopsy remains as the gold standard for the diagnosis of IFALD, but its invasive nature has prompted assessment of noninvasive techniques. Risk factors for IFALD are both nonnutritional (e.g. sepsis) and nutritional. Strict protocols for the prevention of central venous catheter infections in patients with intestinal failure are well established, as is the optimization of the constituents of parenteral nutrition. Further research comparing the available lipid emulsions has become available. Novel approaches at maximizing intestinal absorption are discussed including glucagon-like peptide-2 analogues, as well as surgical approaches. Although there are data on the novel investigative and therapeutic strategies for managing IFALD, further study is required to identify a suitable noninvasive technique for earlier diagnosis and then monitoring of IFALD. Further data are also required on the impact of novel therapies aimed at improving absorption and reducing parenteral nutrition load on IFALD occurrence and progression.

Comparing Two Strategies for Pediatric Nonalcoholic Fatty Liver Disease (NAFLD) Screening

Nonalcoholic fatty liver disease (NAFLD) is a growing disease globally. It is strongly related to obesity and insulin resistance. NAFLD poses a public health issue because it may progress to NASH and subsequently to cirrhosis [1]. Currently, NASH cirrhosis is going to be the second most common cause for chronic liver disease in adult patients awaiting transplantation [2]. There is evidence that its prevalence is also increasing in children which creates an urgent need to identify patients with NAFLD and intervene early.

MicroRNAs as potential markers of parenteral nutrition associated liver disease in adult patients.

Parenteral nutrition-associated liver disease (PNALD) is a severe complication in patients completely dependent on parenteral nutrition (PN). The gold diagnostic standard, liver biopsy, is associated with significant health risk and therefore its use is limited. MicroRNAs (miRNAs) are small non-coding regulatory RNA molecules with highly tissue-specific expression and the secreted miRNAs may serve as non-invasive diagnostic biomarkers. The aim of this study was to evaluate the expression of a panel of specific miRNAs associated with liver diseases of different origin in PN-dependent adult patients in order to design miRNA panel enabling to precise monitoring of PNALD progression. Twelve PN-dependent patients with short bowel syndrome (SBS) were monitored on three/four-month basis for up to 24 months. Forty-five age- and sex-matched subjects without any known liver pathology served as controls. Specific miRNAs expression was determined by RT-qPCR using TaqMan probes (Thermofisher). Liver function test parameters were determined in certified clinical laboratories. Six of the tested miRNAs exhibited significantly altered expression compared with healthy controls, three of them (MIR122, MIR1273g, and MIR500a) were upregulated while three were down-regulated (MIR505, MIR199a, MIR139). MIR122 positively correlated with serum AST and ALT activities while MIR1273g positively correlated with serum CRP concentration and GGT activity. MIR505, MIR199a, and MIR139 negatively correlated with serum GGT activity. Fluctuation of these parameters well paralleled serum miRNA concentrations in all patients throughout the whole observation period. We identified six miRNAs whose serum concentrations are significantly altered in PN-dependent patients with PNALD and correlate with markers of inflammation, cholestasis or hepatic injury. Their reliability as markers of PNALD progression needs to be further evaluated.

Efficacy, safety, and tolerability of lubiprostone for the treatment of non-alcoholic fatty liver disease in adult patients with constipation: The LUBIPRONE, double-blind, randomised, placebo-controlled study design

BackgroundThis paper reports the protocol of a randomised, double-blind, placebo-controlled study to test the efficacy, safety, and tolerability of lubiprostone (LUB) vs. placebo on suppressing gut permeability in non-alcoholic fatty liver disease (NAFLD) patients with constipation. NAFLD, including non-alcoholic steatohepatitis (NASH), is a common chronic liver disorder. Progression is associated with increased gut permeability and gut-derived endotoxins. Most NAFLD/NASH clinical trial drugs aim to improve liver function or systemic metabolism. LUB is a type 2 chloride channel activator used as a laxative for the treatment of patients with constipation. LUB suppresses gut permeability induced by non-steroidal anti-inflammatory drugs in healthy volunteers and lowers blood endotoxin levels. There have been no clinical studies of LUB for NAFLD/NASH patients. MethodsThe study plans to enrol adult patients (20–85 years, planned enrolment, n = 150; planned sample size, n = 120) with NAFLD and constipation, alanine aminotransferase ≥40 IU/L, equivalent steatosis grade ≥1, and equivalent fibrosis stage <4 measured using non-invasive vibration-controlled transient elastography and magnetic resonance imaging. Participants will be randomly allocated into three groups: LUB 12 μg, LUB 24 μg, and a placebo group. ResultsThe primary endpoint will be changes in alanine aminotransferase from baseline at 12 weeks. The main secondary endpoint will be changes in intestinal permeability from baseline at 12 weeks using the lactulose mannitol ratio. ConclusionsThis study will determine whether LUB improves gut permeability in NAFLD patients with constipation. Trial registrationThis trial is registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000026635).

OR03: MIR122 as a Potential Marker of Home Parenteral Nutrition-Associated Liver Disease in Adult Patients: Pilot Study

OR03: MIR122 as a Potential Marker of Home Parenteral Nutrition-Associated Liver Disease in Adult Patients: Pilot Study

Autoantibody Profile of Adult Patients With Childhood Onset Type 2 Autoimmune Hepatitis.

Anti-liver kidney microsome (anti-LKM) autoantibodies are a distinguishing feature of type II autoimmune hepatitis (AIH-2). However, the levels of anti-LKM-1 in adult AIH-2 patients and their role in liver immunopathology remain equivocal. The aim of the study was to survey the autoantibody profile and the activity of liver disease in adult patients diagnosed with AIH-2 at childhood. The autoantibody profile of adults was compared with the autoantibodies of the pediatric period. Liver function test, Immunoglobulin G (IgG), and gamma globulins were evaluated at the AIH presentation, at the age of 18 years, and at the current adult visit. All ten patients tested positive for LKM-1 at least once during the pediatric period. At the adult visit, four patients lost autoantibody positivity. LKM-1 was positive in four, liver cytosol antigen 1 (LC-1) in two, soluble liver antigen in one, and antinuclear antigen in one patient. Additionally three patients with LKM-1 and one patient without LKM-1 were positive for AMA-M2 (where AMA is antimitochondrial antibodies) Immunoglobulin M (IgM). Liver function markedly improved at 18 years and adult visit compared with initial diagnosis of AIH with only a mild decrease of IgG. The six adult patients positive for at least one autoantibody had statistically lower aspartate aminotransferase (AST) and gamma-glutamyltranspeptidase (GGTP) than the four patients autoantibody negative (AST: 52 vs. 88 IU/l, P < 0.05; GGTP 19 vs. 163 IU/l, P < 0.05). LKM-1 positivity is not a stable condition in all patients with AIH-2. Patients who remained autoantibody positive had better liver function tests than those who lost their positivity. The presence of AMA-M2 autoantibodies suggest that development of AIH/Primary Biliary Cirrhosis (PBC) overlap syndrome should be considered.

186 Transient elastography can be used to guide monitoring of cystic fibrosis related liver disease in adult patients

186 Transient elastography can be used to guide monitoring of cystic fibrosis related liver disease in adult patients

High frequency of liver abnormalities in adult cystic fibrosis patients after lung transplantation

Background: CF associated liver disease (CFLD) mainly develops in early childhood and occurs in up to 30% of CF patients including features of steatosis, fibrosis and cholestasis. We aimed at characterizing liver disease in adult patients with CF after lung transplantation (LuTx). Methods: Consecutive patients admitted to our outpatient clinic received ultrasound, fibroscan, MRI/MRCP as well as testing of liver function tests, lipids and vitamin D. Liver diseases of other origins were excluded. Results: 36 patients (median age 30 y, IQR 25 – 38 y; 42% male) were included in the study. Median time since LuTx was 4.5 y (IQR: 2.3 – 8.3 y). Elevated AP/GGT were found in 33%, elevated ALT/AST levels in 28% of patients. In 43% (12/23) of patients steatosis and in 18% (4/23) either fibrosis or liver cirrhosis was diagnosed by ultrasound. In 39% (7/18) of patients MRI/MRCP revealed cholangiectasia, and delayed excretion of contrast medium in 20% (3/15). Fibroscan proved cirrhosis in 2 patients, whereas in all other patients fibrosis 0 to 1 was detected. No association of liver function tests and results of imaging was found. Steatosis was significantly associated with hypertriglyceridemia (p < 0.05), but not with hypercholesterolemia. Vitamin D levels in general were low. However, neither an association of vitamin D, nor gender or BMI with liver disease was evident. Conclusion: About 40% of post transplant patients show bile duct alterations suggesting presence of CFLD. Hepatic steatosis associated with hypertriglyceridemia is a common finding in adult CF patients after LuTx. Liver function tests seem to be a weak parameter for monitoring liver disease in CF patients.

Noninvasive Assessment of Liver Fibrosis in Adult Patients Following the Fontan Procedure

Recent data indicate that patients after the Fontan procedure are at risk for significant liver dysfunction; however, the prevalence and extent of liver disease in the Fontan population remains unknown. Furthermore, limited data exist in regard to screening for liver disease in adult Fontan patients. We sought to determine the prevalence of liver disease in adult patients following the Fontan procedure using computed tomography (CT) and serum biomarkers of liver fibrosis. Adult Fontan patients underwent screening for liver disease as part of their annual evaluation. Screening consisted of laboratory evaluation and dual-phase liver CT scan. Laboratory evaluation included analysis of liver function, viral hepatitis serologies, and FibroSURE panel (LabCorp), a test that analyzes the results of serum biomarkers to provide a quantitative surrogate marker for liver fibrosis. Sixteen patients, mean age 30.3 (range 20-41) years, were enrolled in the study. Mean length of follow-up from time of Fontan palliation was 20.5 (range 11-33) years. No patients had serologic evidence of viral hepatitis or synthetic liver dysfunction. Twelve patients (75%) had abnormal FibroSURE scores, seven (44%) had elevated FibroSURE scores predictive of Metavir fibrosis stage F2 or greater on liver biopsy, and one (6%) had a FibroSURE score predictive of cirrhosis on biopsy. All 16 patients had abnormal radiologic liver findings identified on CT, including heterogeneous enhancement in 11 (69%), varices in six (38%), and liver nodules in five patients (31%). Length of time since Fontan surgery correlated significantly with an elevated FibroSURE score (P = .05) and having more CT scan abnormalities (P = .04). Liver fibrosis detected by serum biomarkers and dual phase CT scan is common in adult patients following the Fontan procedure. Further studies are needed to determine the long-term clinical significance of these findings.

Liver disease in adult patients with cystic fibrosis: A frequent and independent prognostic factor associated with death or lung transplantation

Increased life expectancy in patients with cystic fibrosis (CF) allows better knowledge of non-pulmonary complications like liver disease (CFLD). However, few data have been published in large adult cohorts. The aim of this study was to estimate the prevalence and the prognosis of CFLD in adult CF patients. A retrospective analysis of a monocentric cohort of adult CF patients prospectively followed, at least every year, was performed. CFLD was diagnosed using published composite criteria. If cirrhosis was suspected, upper digestive endoscopy was realized to assess the presence of portal hypertension. A cohort of 285 adult CF patients was followed during 4.8 ± 3.6 years. Among them, 90 had CFLD at the beginning of follow-up and 23 a suspicion of cirrhosis. Factors independently associated with liver disease at baseline were history of meconium ileus, pancreatic insufficiency, chronic colonization with Burkholderia cepacia and the number of IV antibiotic courses per year. Nine patients developed liver decompensation during follow-up, all with a suspicion of cirrhosis at baseline. Six patients underwent liver transplantation alone and three patients combined liver and lung transplantation. Factors independently associated with death or lung transplantation at baseline were liver disease, BMI, forced expiratory volume in 1 second and number of IV antibiotic courses per year. CFLD was present at baseline in one third of adult patients with CF with a marked risk of liver decompensation during follow-up. Moreover, CFLD at baseline appears as an independent factor associated with death or lung transplantation.

Parenteral nutrition related hepato-biliary disease in adults

Parenteral nutrition is a life-saving therapy in patients with intestinal failure. One of the major causes of morbidity and mortality in patients receiving long-term total parenteral nutrition (TPN) is liver disease. Early on, there is steatosis, which can evolve to steatohepatitis and eventually to cholestasis of varying severity. The etiology of parenteral nutrition related liver disease is multifactorial. Provision of excess calories in the TPN solution, along with lipids administered >1 g/kg are thought to increase the risk of parenteral nutrition related liver disease. Other factors such as nutrient deficiencies and nutrient toxicities may also play a role in the pathogenesis of liver disease, along with sepsis and the lack of enteral stimulation. Non-pharmacological management strategies for TPN-related liver disease include enteral stimulation, optimal TPN composition, and avoidance of excess carbohydrate and lipid calories. Pharmacological therapy with ursodeoxycholic acid and antibiotic therapy to reduce the risk of bacterial translocation and sepsis should be considered. Early referral for transplantation should be considered in patients with evidence of portal hypertension. This review focuses on the clinical aspects, pathogenesis, and management strategies of parenteral nutrition-related liver disease in adult patients.