Annals of hepatology最新文献

Introduction and objectives: Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portal shunt (TIPS), affecting patients' quality of life. This study evaluated the efficacy of Clostridium butyricum combined with lactulose in preventing HE after TIPS.

Patients and methods: Patients were randomly divided into two groups: Clostridium butyricum plus lactulose group (trial group) and lactulose group (control group). Prophylaxis started within 24 hours post-TIPS and lasted 3 months. The primary endpoint was the occurrence of HE at 1 and 3 months after TIPS. The study also analyzed the impact on gut microbiota.

Results: No significant difference in minimal hepatic encephalopathy (MHE) incidence between the two groups. However, the trial group had a significantly lower overt hepatic encephalopathy (OHE) incidence than the control group at both one month (8.2 % vs. 26.5 %, P = 0.016) and three months (10.2 % vs. 34.7 %, P = 0.004) (HR=3.867, P = 0.008; aHR=4.819, P = 0.004). The trial group showed a higher skeletal muscle index at the third lumbar vertebra at 3 months after TIPS (42.85 ± 10.66 vs. 38.38 ± 8.61 cm²/m², P = 0.024). Combining treatment can reduce the occurrence of OHE in patients with sarcopenia (48.3 % vs. 15 %, P = 0.016). The abundance of butyrate-producing bacteria and the level of butyric acid in the trial group at 3 months after TIPS was significantly increased compared to the baseline. The levels of TNF-α and D-LDH in the trial group were significantly lower than those in the control group at 3 months after TIPS.

Conclusions: Clostridium butyricum plus lactulose can significantly reduce the incidence of OHE after TIPS and improve nutritional status. In addition, combined therapy can also increase the abundance of beneficial bacteria in stool, increase the level of butyric acid in stool, and improve the inflammatory state in patients undergoing TIPS.

Introduction and objectives: Hepatocellular carcinoma (HCC) and portal hypertension (PHT) are two common complications of cirrhosis that often co-exist and significantly affect patient prognosis, yet global management varies widely. This study evaluated Chinese physicians' perspectives on PHT screening and management in HCC.

Materials and methods: An online questionnaire survey was distributed to hepatologists, gastroenterologists, gastrointestinal oncologists, and hepatobiliary surgeons across 132 hospitals in 16 provinces throughout China from March 1, 2024, to June 30, 2024. The questionnaire comprised 57 items across four sections. This study was approved by Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. 2024-0365) and registered at the Chinese Clinical Trial Registry (ChiCTR2400084630).

Results: Overall, 1,584 participants responded to the questionnaire. The reported PHT screening rate in HCC patients was 82.6%. Imaging was the most common modality (50.5%), followed by endoscopy (30.8%). However, adherence to the Baveno VI/VII consensus was only 28%. Complications of PHT, including gastrointestinal bleeding and ascites, significantly affected physicians' screening practices. The primary and secondary prophylaxis strategies for PHT generally comply with the Baveno VII consensus. A history of acute variceal bleeding within 6 months significantly reduced the preference for atezolizumab and bevacizumab therapy (19.6% vs. 32.9%, P<0.001). In cases of acute variceal bleeding during atezolizumab-bevacizumab therapy, 79.5% of the physicians recommended permanent discontinuation of bevacizumab, whereas 20.5% advocated continuation upon achieving hemostasis.

Conclusions: Substantial heterogeneity exists in the management of PHT among HCC patients in China, highlighting the need for targeted multidisciplinary education to standardize care and improve patient outcomes.

Over the past few decades, the profile of liver diseases in Africa and the Middle East has undergone significant changes. The incidence of metabolic dysfunction-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the seriousness of the situation, there is a scarcity of local or regional guidelines established to address it. This document presents the clinical practice guidelines from the African Middle East Association of Gastroenterology (AMAGE) related to the screening, diagnosis, and management of MAFLD. It addresses multiple aspects of managing this condition while taking into account local circumstances and the healthcare system's management requirements. These guidelines are intended for routine clinical use, with a specific focus on particular groups when needed.

Introduction and objectives: De novo malignancy (DNM) is a major late hazard after liver transplantation (LT), usually due to cumulative immunosuppression, viral oncogenesis, and host/environmental factors. Robust Brazilian multicenter data remain scarce. This study assessed burden, spectrum, timing, and post-cancer outcomes in a long-horizon national cohort.

Materials and methods: Retrospective cohort of all orthotopic LT recipients from three Brazilian programs (1991-2022), with follow-up through June 1, 2024. Primary epidemiology used competing-risk methods (Aalen-Johansen with death as a competing event) for non-cutaneous DNM; Kaplan-Meier (KM) was reported for cross-study comparability. Overall survival (OS) was estimated from the first eligible DNM diagnosis in a prespecified clinical subset (excludes non-melanoma skin cancer [NMSC] and recurrent hepatocellular carcinoma; melanoma included).

Results: The analytic cohort comprised 1234 recipients; 142 developed post-LT malignancy, of whom 121 had ≥1 DNM. NMSC led the spectrum, followed by gastrointestinal neoplasms. Ten-year cumulative incidence of non-cutaneous DNM by Aalen-Johansen was 3.5 % (95 % CI 2.6-4.6); KM risks at 10 years were 9.8 % for any DNM and 6.3 % for non-cutaneous DNM. In the OS subset (n = 80), survival from first cancer diagnosis declined over time (primary: 1y 80.5 %, 3y 69.8 %, 5y 47.3 %; sensitivity: 1y 78.0 %, 3y 67.2 %, 5y 44.0 %). Temporal patterns showed sustained incidence beyond 5-10 years.

Conclusions: In a 30-year multicenter Brazilian cohort, DNM constituted a major late complication after LT with persistent risk into late survivorship and clinically meaningful attrition after non-cutaneous cancers. These findings support lifelong, risk-adapted and oncologically mindful immunosuppression, tailored to regional epidemiology and access to longitudinal care.