278 research outputs found
Advocating for the implementation of the new nomenclature for steatotic liver disease: A call to action for the national associations
Get PDFHepatic encephalopathy: Part 1, a diagnostic approach
No full textThe first of this three-part review provides an overview of the clinical features, differential diagnoses and practical approach to the patient with hepatic encephalopathy (HE). HE is a debilitating condition seen in acute and chronic liver disease and/or portal-systemic shunting. Decades of research support the pathophysiological determination of a synergistic effect of gut-derived inflammation, infection and ammonia in its development. While HE is a distinct clinicopathological entity, patients with liver disease or portal hypertension remain vulnerable to other causes of altered mental state common in the general population. As there is no definitive test for overt HE, diagnosis relies on exclusion of differential diagnoses, considering several treatable conditions. We propose a four-step approach for identifying HE in patients presenting to the emergency department or outpatient clinics: (1) defining the underlying disease, (2) clinical characterisation, (3) identifying precipitants and risk factors and (4) excluding alternative diagnoses. Additionally, we will discuss the use of neuropsychological and neurophysiological testing for the diagnosis of covert HE. The second instalment of this review series will cover the investigation and management of HE in acute and acute-on-chronic liver failure, and the third instalment will cover outpatient management of HE
Economic evaluation of a stratified transport method for Atlantic halibut (Hippoglossus hippoglossus) juveniles
No full textThe objective of this study was to evaluate a convenient, low-cost modification to conventional transfer methods for Atlantic halibut juveniles. A series of wire mesh cages were stacked within transport tanks creating a stratified transport system (STS), increasing the surface area for settlement and facilitating a more homogeneous distribution of halibut throughout the tank compared with the conventional insulated box (Unstructured, UTS). A stochastic cost-benefit analysis determined investment into a STS to be cost-effective, generating a mean benefit-cost ratio of 1.31 (95% CI, 0.68–2.00) after 2 years and a mean 5-year net present value of 85,176(9546,906–$125,630). The implementation of a STS was found to be technically feasible and economically efficient method to improve Atlantic halibut transport.Peter J. Sykes, Carol A. McClure, Debbie J. Martin-Robichaud, Charles G. Caraguel, K. Larry Hammel
Real-world evidence of long-term survival and healthcare resource use in patients with hepatic encephalopathy receiving rifaximin-α treatment: a retrospective observational extension study with long-term follow-up (IMPRESS II)
No full textObjective: To describe survival of patients with hepatic encephalopathy (HE), up to 5 years after initiation of rifaximin-α (RFX) treatment.Design/Method: A retrospective, observational extension study within 9 National Health Service secondary/tertiary UK care centres. All patients had a clinical diagnosis of HE, were being treated with RFX and were included in the previous IMPRESS study which reported the 1-year experience. Demographics, clinical outcomes, selected cirrhosis-related complications, hospital admissions and attendances up to 5 years from RFX initiation were extracted from patient medical records and hospital electronic databases. The primary outcome measure was survival at 5 years post-initiation of RFX treatment.Results: The study included 138 patients. The survival rate at 5 years post-initiation of RFX was 35% (95% CI 28.2% to 44.4%) overall and 36% (95% CI 26.1% to 45.4%) for patients with alcohol-related liver disease. Median survival from RFX initiation was 2.8 years (95% CI 2.0 to 3.8; n=136). Among 48 patients alive at 5 years, 69% remained on RFX treatment at the end of the observation period, 74% reported no cirrhosis-related complications and 24% (9/37) had received a liver transplant. Between 1 and 5 years post-initiation, total numbers of liver-related emergency department visits, inpatient admissions, intensive care unit admissions and outpatient visits were 84, 194, 3 and 709, respectively; the liver-related 30-day readmission rate was 37%.Conclusion: Within UK clinical practice, RFX use in HE was associated with a 35% survival rate with high treatment adherence, 76% transplant-free survival rate, minimal healthcare resource and low rates of complications at 5 years post-initiation
Diagnosis and management of hepatic encephalopathy
No full text Overt and covert hepatic encephalopathy (HE) are debilitating complications of cirrhosis. HE results in a poor quality of life for patients and their caregivers and, unless there is access to liver transplantation, the prognosis is poor. The development of overt HE is often unpredictable, and its management, particularly in the ward, remains challenging. There is an urgent need for novel approaches to treat HE. Until recently, therapies for this complication were disappointing, with frequently intolerable side effects such as diarrhoea and faecal incontinence. However, a non-absorbable antibiotic, rifaximin, * has been approved for the prevention of recurrent overt HE. It aims to reduce hospitalisation and resource use, as well as improve patients' quality of life. This article describes the practical aspects of diagnosing, classifying and managing HE. It reviews the pharmacological options for the treatment and prophylaxis of overt HE, and explores the evidence base demonstrating that rifaximin reduces the recurrence of overt HE </jats:p
Is it time to target gut dysbiosis and immune dysfunction in the therapy of hepatic encephalopathy?
No full textThe development of overt hepatic encephalopathy (HE) in a patient with cirrhosis confers a damning prognosis with a 1-year mortality approaching 64%. This complex neuropsychiatric syndrome arises as a consequence of a dysfunctional gut-liver-brain axis. HE has been largely neglected over the past 30 years, with the reliance on therapies aimed at lowering ammonia production or increasing metabolism following the seminal observation that the hepatic urea cycle is the major mammalian ammonia detoxification pathway and is key in the pathogenesis of HE. The relationship with ammonia is more clear-cut in acute liver failure; but in cirrhosis, it has become apparent that inflammation is a key driver and that a disrupted microbiome resulting in gut dysbiosis, bacterial overgrowth and translocation, systemic endotoxemia and immune dysfunction may be more important drivers. Therefore, it is important to re-focus our efforts into developing therapies that modulate the disrupted microbiome or alleviating its downstream consequences.</p
Important Unresolved Questions in the Management of Hepatic Encephalopathy: An ISHEN Consensus
No full textManagement of hepatic encephalopathy (HE) remains challenging from a medical and psychosocial perspective. Members of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism recognized 5 key unresolved questions in HE management focused on (i) driving, (ii) ammonia levels in clinical practice, (iii) testing strategies for covert or minimal HE, (iv) therapeutic options, and (v) nutrition and patient-reported outcomes. The consensus document addresses these topical issues with a succinct review of the literature and statements that critically evaluate the current science and practice, laying the groundwork for future investigations
- …
