World Journal of Hepatology最新文献

Background: The gut microbiome is associated with hepatic encephalopathy (HE), but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.

Aim: To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.

Methods: We searched the PubMed, Web of Science, EMBASE, and Cochrane databases using two keywords, HE, and gut microbiome. According to the inclusion and exclusion criteria, suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE. The data were analyzed using RevMan and STATA.

Results: Seventeen studies were included: (1) A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE [-0.20, 95% confidence interval (CI): -0.28 to -0.13, I² = 20%]; (2) The relative abundances of Lachnospiraceae (-2.73, 95%CI: -4.58 to -0.87, I² = 38%) and Ruminococcaceae (-2.93, 95%CI: -4.29 to -1.56, I² = 0%) in liver cirrhosis patients with HE was significantly lower than those in patients without HE; (3) In patients with HE, Enterococcus, Proteobacteria, Enterococcaceae, and Enterobacteriaceae proportions increased, but Ruminococcaceae, Lachnospiraceae, Prevotellaceae, and Bacteroidetes proportions decreased; (4) Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected; and (5) Differential gut microbiomes may serve as diagnostic and prognostic tools.

Conclusion: The gut microbiomes of patients with liver cirrhosis with and without HE differ. Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.

This letter discusses the recent study by Mukherjee et al, which identifies a significant prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among newly diagnosed type 2 diabetes mellitus (T2DM) patients in Bihar, India, and underscores the pressing need for integrated MASLD management within T2DM care. With 72.3% of the study cohort affected by MASLD, implementing routine liver function tests and ultrasound screenings is recommended as a standard practice in diabetes care, especially in regions with high prevalence rates. The study also advocates for dietary and lifestyle modifications, particularly the reduction of saturated fats, to slow MASLD progression. Patient education on monitoring body mass index and waist circumference, coupled with the integration of these metrics into digital health records, could enhance patient involvement and support proactive health management. Moreover, the letter emphasizes the advantages of developing a region-specific MASLD risk model that incorporates local dietary patterns and socioeconomic factors. Continued research into genetic and environmental determinants of MASLD remains essential for advancing our understanding of its etiology and informing targeted public health strategies.

Hepatitis B virus (HBV) infection causes acute and chronic hepatitis, compensated and decompensated cirrhosis, and hepatocellular carcinoma worldwide. The actual status of HBV infection and its treatment in certain regions of Asian and African countries, including Ethiopia, has not been well-documented thus far. Antiviral therapy for HBV infection can prevent the progression of HBV-related liver diseases and decrease the HBV-related symptoms, such as abdominal symptoms, fatigue, systemic symptoms and others. In Eastern Ethiopia, HBV-infected patients with cirrhosis were found to be positive for the HBV e antigen and to have a higher viral load than those without cirrhosis. Notably, 54.4% of patients practiced khat chewing and 18.1% consumed excessive amounts of alcohol. Tenofovir disoproxil fumarate effectively suppressed HBV DNA in those infected with HBV. It is important to elucidate the actual status of HBV infection in Eastern Ethiopia to eliminate HBV infection worldwide by 2030. HBV vaccination and the educational programs for Health Science students that provide practical strategies could help to reduce HBV infection in Eastern Ethiopia.

Background: Necrotizing fasciitis (NF) is a potentially fatal bacterial infection of the soft tissues. Liver cirrhosis appears to be a contributing factor to higher morbidity and mortality in patients with NF. This research article explores the relationship between these two conditions.

Aim: To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF, focusing on inpatient mortality, septic shock, length of stay, and hospital costs.

Methods: This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample. Cases were identified as patients with both NF and cirrhosis, while controls were non-cirrhotic. The study focused on inpatient mortality as the primary outcome, with secondary outcomes including surgical limb amputation, mechanical ventilation rates, septic shock, length of stay, and hospital costs.

Results: A total of 14920 patients were admitted to the hospital for management of NF, of which 2.11% had liver cirrhosis. Inpatient mortality was higher in cirrhotic patients (9.5% vs 3%; adjusted odds ratio = 3.78; P value = 0.02). Cirrhotic patients also had higher rates of septic shock (10.5% vs 4.9%, P value < 0.01). Length of hospital stay, total charges, and rates of mechanical ventilation were not statistically different between groups.

Conclusion: Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF. Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.

Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus (HBV) infection within the first 12-24 hours. Detection of hepatitis B surface antibody (HBsAb) resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response. This makes it difficult to detect HBV infection. For this reason, it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunoprophylaxis at birth should have HBsAb testing when they are 9-15 months old.

Background: Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis.

Aim: To analyze the association between Child-Turcotte-Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort.

Methods: This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged > 18 years. Diagnosis of cirrhosis was made by liver biopsy. The first year of data collection was 2007, and data regarding outcomes were collected in 2023. Data were gathered from medical records, and grouped by different methods, including CTP, handgrip strength, and triceps skinfold cutoffs. The prognostic values for mortality were assessed using Kaplan-Meier curves and multivariate binary logistic regression models.

Results: The coefficient for CTP was the only statistically significant variable (Wald = 5.193, P = 0.023). This suggests that with a negative change in CTP classification score, the odds of survival decrease 52.6%. The other evaluated variables did not significantly predict survival outcomes in the model. Kaplan-Meier survival curves also indicated that CTP classification was the only significant predictor.

Conclusion: Although different classifications showed specific differences in stratification, only CTP showed significant predictive potential. CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.

Background: Liver fibrosis and cirrhosis are global medical challenges that require safe and effective treatments. In the past two decades, there has been a surge in research on stem cell therapy for liver fibrosis and cirrhosis. This study aimed to conduct a comprehensive analysis of the research hotspots and trends in this field through bibliometrics.

Aim: To conduct a bibliometric analysis on hotspots and trends in stem cell therapy for treatment of liver fibrosis and cirrhosis.

Methods: Publications on stem cell therapy for liver fibrosis and cirrhosis were retrieved from the Web of Science Core Collection database. The distribution and collaboration among literature, authors, countries, and institutions were analyzed visually using Excel, CiteSpace, Bibliometrix R-package, VOSviewer and Pajek software. Additionally, an investigation of keywords, burst keywords, and clusters was conducted.

Results: As of September 20, 2024, a total of 1935 documents were retrieved dating from 2004 to 2024, with 1186 strongly relevant publications obtained after screening. China, the United States, and Japan were the major contributors in this field. Cairo University, Zhejiang University and Yamaguchi University were the major institution in this field. The journal Stem Cell Research & Therapy published the most papers. There were 686 authors, with Shuji Terai, Isao Sakaida, Soon Koo Baik, and Lanjuan Li publishing the most papers. The research focused on alcoholic cirrhosis and nonalcoholic fatty liver disease. The emerging areas of interest were extracellular vesicles, exosomes, and their enriched microRNAs. The field is experiencing rapid growth due to the changing research trends and increasing literature.

Conclusion: These findings provide a thorough overview of stem cell therapy in the field of liver fibrosis and cirrhosis.

People with advanced chronic liver disease (ACLD) have an enhanced risk of malnutrition, which has multifactorial etiology and is mainly linked to a reduced energy and protein intake; malnutrition is critical for patients with cirrhosis since it is often associated with sarcopenia, a skeletal muscle depletion with a loss of muscle mass and function. Late-evening snacks have been extensively studied, and guidelines are recommended to counteract the effects of prolonged fasting at night in patients with ACLD. However, it has not been fully explored whether late evening snacking is clarified as a milestone to address the nutritional needs of people with ACLD or whether it has a potential role in improving body composition. In this randomised control trial, Yu et al demonstrated that long-term nocturnal snacks have the potential to significantly improve body composition by body fat mass, visceral fat area and body cell mass in patients with ACLD. While the improvement in skeletal muscle mass was minor, the promising results in other compositions provide hope for future research and patient care.

This letter discusses the research conducted by Abdel-Razeq et al, highlighting a significant association between Helicobacter pylori (H. pylori) infection and metabolic dysfunction-associated steatohepatitis (MASH) in individuals with a prior history of H. pylori infection. Using a comprehensive patient database, the study establishes an independent correlation between H. pylori and an elevated risk of MASH, even after adjusting for coexisting conditions such as obesity, type 2 diabetes, and dyslipidemia. Notably, the findings suggest that H. pylori may worsen liver pathology through inflammatory pathways, contributing to hepatic insulin resistance and lipid accumulation. Although the study provides strong evidence for this association, limitations related to diagnostic heterogeneity indicate a need for further research to clarify the underlying mechanisms and to explore the potential roles of genetic and microbiome factors in this relationship.

Background: The treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) has focused on the control of comorbidities. Silybum marianum (SM) and alpha-lipoic acid (ALA) have shown antioxidant and adjuvant effects on the control of metabolic disorders.

Aim: To evaluate whether the SM-ALA formulation (LUDLEV^®), in combination with the Mediterranean diet (MD), could improve MASLD-related liver injury.

Methods: A randomized, double-blind clinical trial was conducted on patients with MASLD. Administration of SM-ALA plus MD (group A) vs placebo plus MD (group B) was compared for 24 weeks. At baseline and weeks 12 and 24, anthropometric measurements, metabolic parameters, and liver function were analyzed. Clinical effectiveness was evaluated through transient elastography.

Results: Fifty patients aged 54 ± 10 years were included, and the majority (74%) were female. Reduced visceral fat and umbilical circumference were reported in both groups, with significance in group A (P = 0.045 and 0.003, respectively). The decrease in controlled attenuation parameter was gradual and maintained at 12 and 24 weeks in group A (P = 0.026), whereas in group B the decrease was greater at week 12 and remained unchanged at week 24 (^∆controlled attenuation parameter: -27 dB/m). Mild adverse effects were reported in 4 patients in group A (16%) and 4 patients in group B (16%), with no significant differences between groups (P = 0.641).

Conclusion: SM-ALA (LUDLEV^®) combined with the MD can promote the improvement of metabolic parameters, reducing visceral fat and hepatic steatosis in Mexican patients with MASLD.