Minerva gastroenterology最新文献

Introduction: Portopulmonary hypertension (PoPH) occurs in roughly 5% of patients evaluated for liver transplant and increases perioperative morbidity and mortality. PoPH patients often succumb to complications of the underlying liver disease, therefore liver transplantation can be a lifesaving intervention. Medical treatment of PoPH optimizes patients for transplantation, but the knowledge on the effect of PH specific therapy on transplant eligibility is limited.

Evidence acquisition: We searched Medline, Embase, and Cochrane Library from inception to August 19, 2024. We aimed to include studies of adult patients with PoPH treated with pharmacologic therapies with comparison to placebo, baseline condition of the patient, or another medication. We only included studies where liver transplantation outcomes were reported.

Evidence synthesis: Out of 606 studies retrieved, 17, all observational cohorts, met inclusion criteria. None of the included studies had suitable control or comparison groups to assess medication efficacy in a pooled fashion. As a result, this systematic review aimed to describe the effect of PoPH treatments on transplant eligibility across studies and medication classes. A total of 812 patients received medical treatment, with 52% receiving liver transplant. Of studies reporting transplant eligibility, 65% of treated PoPH patients became transplant eligible.

Conclusions: Within the limitations of the available data, PoPH therapies improve transplant eligibility. Prospective studies, especially RCTs, are needed to better define the best treatment strategy in this population.

The need for objective diagnostic tools in people with alcohol intake abuse is one of the major needs in daily clinical practice. Determination of blood alcohol concentration is commonly used in cases of suspected acute alcohol intoxication, especially in the emergency room. A dose-dependent correlation between alcohol consumption and mean corpuscular volume (MCV) is a known index of excessive alcohol intake. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are frequently elevated (2-4 times above normal) in patients with alcohol use disorder and an AST/ALT ratio >2 is indicative of alcohol-related liver disease. Several studies highlighted a positive correlation between alcohol consumption and serum gamma-glutamyl transferase (γGT) levels, with increased values in about 75% of patients drinking >60 g/day of ethanol for at least 5 weeks. Also, 60-80 g of alcohol per day for a minimum of 2 weeks can result in increased carbohydrate-deficient transferrin (CDT) levels (normally less than 2% of total transferrin). Complete abstinence from alcohol leads to a normalization of CDT values in approximately 2-3 weeks. Ethyl glucuronide (EtG) is detectable in urine from a minimum of 6 hours up to a maximum of 100 hours after alcohol intake. In-vitro studies showed that the levels of phosphatidylethanol (PEth) in human red blood cells were proportional to ethanol concentration and exposure time, suggesting an important role in differentiating abstinence from unhealthy drinking. γGT and CDT are the most useful markers for monitoring chronic alcohol abstinence, whereas blood alcohol concentration and urinary EtG are the most valuable indexes of acute alcohol consumption. In conclusion, no specific laboratory marker alone is reliable to identify patients with alcohol abuse, thus the best diagnostic strategy includes combined index use in addition to other screening tools (i.e., clinical history/context and questionnaires).

Spontaneous portosystemic shunts (SPSSs) are common among patients with liver cirrhosis. These vascular structures are collateral veins that directly connect the portal vein system with the systemic circulation. The prevalence increases as cirrhosis worsens. Published studies exist investigating the possible association between presence and extension of SPSSs and clinical manifestation of liver cirrhosis, however some issues continue to be debated. Recent research on this topic has extended knowledge and brought out interesting new aspects. The aim of this review is to provide a comprehensive and updated revision of the role of SPSSs in liver cirrhosis, from pathophysiology to clinical and therapeutic considerations, specifically addressing the most controversial and emerging findings. On this purpose PubMed and Medline were used as data sources and an extensive review of the literature, including the most recent and relevant published studies, was performed. The presence of SPSSs, especially if multiple and/or large, is associated with an increased risk of developing several complications of liver cirrhosis. Patients with higher MELD have larger SPSSs with negative impact on survival. Regarding hepatocellular carcinoma, there is evidence suggesting a potential tumorigenic effect associated with SPSSs, but further investigations on humans are needed. In the context of liver transplantation, the negative effect of SPSSs on graft function and patients' survival is a matter of debate, with no consensus on their surgical management. Currently, several interventional treatments have been proposed for SPSSs that have demonstrated excellent outcomes in selected populations.

Chronic hepatitis B (CHB) remains a leading cause of liver disease worldwide, with liver fibrosis being a key determinant of long-term prognosis. This narrative review provides a detailed examination of the pathogenesis, diagnosis, and management of liver fibrosis associated with CHB. The review outlines the complex mechanisms driving fibrosis, including viral replication, immune response, and hepatic stellate cell activation, which collectively contribute to liver damage. It also evaluates current diagnostic techniques, such as non-invasive biomarkers, imaging modalities, and liver biopsy, emphasizing their clinical utility and accuracy in assessing the fibrosis stage. The management section covers antiviral therapies, their role in halting disease progression, and emerging antifibrotic agents to reverse fibrosis. Additionally, the review discusses the importance of early detection and tailored treatment strategies in improving patient outcomes. By synthesizing the latest evidence, this review provides insights into the evolving landscape of chronic hepatitis B-related liver fibrosis and highlights ongoing challenges in its diagnosis and management.

Advanced liver disease is a global health challenge which requires a timely and accurate diagnosis for optimal patient management. Traditionally, liver biopsy has been the gold standard for diagnosing and staging liver diseases; however, its invasiveness and associated risks, including bleeding, infection, and sampling errors, limit its utility. Non-invasive tests (NITs) have emerged as critical tools in liver disease evaluation, offering safe and effective alternatives to biopsy. This review explores the spectrum of NITs, highlighting their benefits, limitations, and clinical applications in specific liver diseases. NITs have demonstrated significant utility in monitoring chronic viral hepatitis, metabolic-associated steatotic liver disease (MASLD), and cholestatic liver diseases, reducing the need for invasive procedures. While further refinement and validation are needed, NITs represent a major advancement in liver disease management, enhancing early diagnosis, monitoring treatment response, and improving patient outcomes. This review delves into the various non-invasive tests employed in liver disease evaluation, emphasizing their benefits, limitations, and clinical applications. By examining the current landscape of NITs, we aim to elucidate how these advancements are revolutionizing the diagnosis and management of liver diseases, ultimately enhancing patient care and outcomes.

Helicobacter pylori is responsible for several gastrointestinal disorders, of which gastric cancer is the most concerning. Given the racial and ethnic disparities seen with H. pylori infection and gastric cancer in the U.S., certain populations (immigrants, non-white racial groups) remain at high-risk. While several guidelines recommend screening for H. pylori in these high-risk groups, specific guidance on how to implement population screening and the cost-effectiveness of this approach is lacking. Here we discuss several controversies including the cost-effectiveness and implementation of a population-based H. pylori screening program, empiric vs. tailored therapy based on antibiotic susceptibility, and the role of potassium-competitive acid blockers (PCABs) in H. pylori treatment. With the rapidly changing landscape of H. pylori management, here we review the latest studies and guidelines for practical clinical application.

Helicobacter pylori (H. pylori) infection is the main cause of the most frequent gastroduodenal diseases and gastric atrophy, with or without intestinal metaplasia, which predisposes to gastric cancer development. Gastric juice analysis may be useful in diagnosing these conditions, revealing the H. pylori infection and hypochlorhydria status by measuring ammonium concentrations and pH levels. EndoFaster^® is a device introduced to perform these analyses on gastric juice in real-time. The available data showed very high negative predictive values in ruling out the infection and corpus atrophic gastritis, thereby potentially reducing the need for gastric biopsies when test results are negative. This review aims to assess the potential role of EndoFaster^® in supporting the diagnosis of H. pylori infection, detecting gastric precancerous lesions, and other specific clinical applications, potentially reducing unnecessary gastric biopsies.