Clinical Gastroenterology and Hepatology最新文献

Introduction: Chronic liver disease is a known risk factor for cholangiocarcinoma (CCA), but the proportion of people with CCA who have concurrent chronic liver disease is unclear. We aimed to evaluate the prevalence of chronic liver diseases in people with cholangiocarcinoma.

Methods: In this single-arm meta-analysis, we searched MEDLINE and EMBASE from inception to 10 August 2024 for articles in English containing data for cholangiocarcinoma with and without chronic liver diseases. Data were pooled to obtain the prevalence of different chronic liver diseases, with further stratification by geographical location and tumor location.

Results: In total, 118068 individuals diagnosed with cholangiocarcinoma were included, of whom 16771 had chronic liver diseases. A pooled analysis of 109 studies determined that the prevalence of chronic liver disease was 25.23% (95% CI: 20.82% - 30.23%; I²=99.0%), and 10.21% (7.75% - 13.35%; I²=98.6%) of CCA patients had cirrhosis. Chronic liver diseases were associated more with intrahepatic CCAs, compared to extrahepatic CCAs (RR: 2.46, CI: 2.37 - 2.55, p < 0.0001). This was observed across all etiologies of liver disease, except for primary sclerosing cholangitis which was associated with extrahepatic CCAs (RR: 0.49; CI: 0.43 - 0.57, p < 0.0001).

Conclusion: Around one in four people with cholangiocarcinoma have chronic liver diseases, and one in ten have cirrhosis.

Background and aims: The specific causative role of HDV infection in the development of hepatocellular carcinoma (HCC) remains debated and was not specifically demonstrated in cirrhotic patients. Here we compared HCC incidence in HBV-HDV co-infected and HBV mono-infected cirrhotic patients.

Methods: A total of 142 HBV-HDV and 271 HBV-infected cirrhotic patients from the French ANRSCO12 CirVir and DeltaVir cohorts, with histologically proven cirrhosis and no history of decompensation, were included in the study.

Results: HBV-HDV patients were younger than HBV patients (37.2 vs. 53.8 years), they were more often immigrants from sub-Saharan Africa, and displayed less co-morbidities and more altered liver tests. After adjustment for age, cumulative incidences of HCC in co-infected and mono-infected patients at 1, 3 and 5 years were 5.2%, 11.8% and 20.2% vs. 1.1%, 2.5% and 4.4%, respectively (P< .001). In multivariate analysis, HDV infection was an independent factor associated with the development of HCC (HR 2.94, 95% CI 1.19-7.25; P= .019). Other independent factors were age (HR 1.08, 1.05-1.11; P< .001), overweight (HR 0.45, 0.22-0.93; P= .031), smoking (HR 2.26, 1.23-4.16; P= .009), increased GGT (HR 2.73, 1.24-6.00; P= .013), total bilirubin >17 μmol/L (HR 2.68, 1.33-5.42; P= .006) and platelet count <150.000/mm³ (HR 3.11, 1.51-6.41; P= .002). HDV co-infection was not an independent factor of liver decompensation, transplantation or death.

Conclusion: The incidence of HCC appears significantly higher in HBV-HDV than in HBV-infected cirrhotic patients. HDV infection emerges as an independent risk factor for HCC, indicating that in cirrhotic patients, HDV plays a causative role for HCC independently of HBV.

Background and aims: Improvement in the nutritional status of Acute on Chronic Liver Failure(ACLF) patients may lead to reduction in morbidity and mortality. This study assessed the impact of dietician supported outpatient intensive nutrition therapy(OINT) on survival and frailty in patients with alcohol related ACLF METHODS: 70 patients with alcohol related ACLF(Asia Pacific Association for the Study of the Liver, APASL-criteria) and frailty were randomized 1:1 to receive standard medical therapy(SMT) plus OINT(intervention) versus SMT(control) alone. The primary outcome was an improvement in survival at 3 months. Secondary outcome measures included improvement in frailty, prognostic scores and hospitalization.

Results: There was a significant improvement in overall survival in the OINT group as compared to SMT after 3 months of follow up, 91.4% (Standard error (SE): 4.7%) vs. 57.1% (SE: 8.4%), P<.00). On cox regression model, inclusion in the intervention arm, baseline Skeletal Muscle Index(SMI), and Asia Pacific Association for the Study of the Liver ACLF Research Consortium(AARC score) were independent predictors of survival (P<.05). The Liver frailty index(LFI) score also significantly improved in the OINT as compared to SMT, Δ-0.93 -(0.71-1.13) vs. Δ -0.33 -(0.44-0.72)(P<.00). The disease severity including MELD, MELD-Na, and AARC score showed a significant improvement in the OINT group as compared to the SMT group(P<.05). The patients in OINT group had lesser number of hospitalizations 6(17%) versus 16(45.7%)(P=.01) as compared to SMT group.

Conclusion: Outpatient intensive nutrition therapy significantly improves survival, frailty and disease severity with a reduction in number of hospitalizations and supports the key role of nutrition in treatment of alcohol related ACLF patients.