Article
Gastroenterology & Hepatology
Priti Vijay, Bikrant Bihari Lal, Vikrant Sood, Rajeev Khanna, Yashwant Patidar, Seema Alam
Summary: The study found that optic nerve sheath diameter (ONSD) is an effective indicator for detecting raised intracranial pressure in pediatric acute liver failure patients. An ONSD greater than 4.55 mm indicates elevated ICP. Timely reduction in ONSD can predict patient outcomes.
HEPATOLOGY INTERNATIONAL
(2021)
Review
Biochemistry & Molecular Biology
So Yeong Cheon, Juhyun Song
Summary: Hepatic encephalopathy and diabetic encephalopathy are emerging types of neurological diseases characterized by cognitive and motor impairments. The relationship between metabolic organs and the brain plays an important role in the pathogenesis of neurological diseases.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2021)
Article
Gastroenterology & Hepatology
Rajiv Jalan, Christopher F. Rose
Summary: The clinical progress in managing hepatic encephalopathy lags behind basic research, making current criteria for definition, classification, diagnosis, and grading difficult to apply reproducibly. Studies suggest that hepatic encephalopathy may be irreversible in many patients, requiring further research into neuronal injury and death mechanisms for future drug development. Lactulose, currently considered the standard of care, has poor clinical evidence for all severity levels of hepatic encephalopathy, and ethical consideration should be given to placebo-controlled trials.
JOURNAL OF HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Viniyendra Pamecha, Nilesh Sadashiv Patil, Sanyam Falari, Nihar Mohapatra, Anubhav Harshit Kumar, Gaurav Sindwani, Neha Garg, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal
Summary: This study aimed to investigate the challenges and outcomes of live-donor liver transplantation (LDLT) for pediatric acute liver failure (PALF). A total of 315 patients with PALF were treated over 11 years, and 42 underwent liver transplantation. The outcomes of LDLT for PALF were analyzed.
HEPATOLOGY INTERNATIONAL
(2023)
Review
Medicine, General & Internal
Young-Kook Kim, Juhyun Song
Summary: Hepatic encephalopathy is a common complication in patients with liver cirrhosis, involving various pathogeneses such as ammonia-induced oxidative stress and neuronal cell death. Researchers are exploring the effects of resveratrol on neuropathogenesis and the gut-liver axis to potentially improve the treatment of hepatic encephalopathy.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Immunology
Wouter Claeys, Lien Van Hoecke, Hannah Lernout, Clint De Nolf, Griet Van Imschoot, Elien Van Wonterghem, Daan Verhaege, Jonas Castelein, Anja Geerts, Christophe Van Steenkiste, Roosmarijn E. Vandenbroucke
Summary: Hepatic encephalopathy, a complication of liver cirrhosis, lacks brain-targeted therapies. Astrocytes and microglia have been implicated in its development. RNA-Seq analysis of sorted astrocytes and microglia in a mouse model of hepatic encephalopathy revealed transcriptional responses, particularly in microglia, enriched in inflammation and hypoxia pathways. Astrocytes showed increased corticoid receptor and oxidative stress signaling, while microglial transcriptome changes were linked to immune cell attraction. This study provides insights into the molecular mechanisms of hepatic encephalopathy and potential glial-directed therapeutic strategies.
JOURNAL OF NEUROINFLAMMATION
(2023)
Article
Biochemistry & Molecular Biology
Kazuhiko Nakadate, Sumito Kamata
Summary: This study investigated the pathological changes associated with acute hepatic encephalopathy in a mouse model. The results showed that ammonium acetate treatment caused enlargement of the lateral ventricles and swelling of the choroid plexus. Additionally, there were changes in the localization of aquaporin-1 after treatment.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Critical Care Medicine
Jakob Pansell, Robert Hack, Peter Rudberg, Max Bell, Charith Cooray
Summary: This study evaluated the Neurological Pupil index (NPi) as a noninvasive screening tool for elevated intracranial pressure (ICP), and found that NPi within a certain range can rule out the possibility of elevated ICP while also aiding in estimating the probability of elevated ICP. The results suggest that NPi is of great significance for clinical decision-making.
NEUROCRITICAL CARE
(2022)
Review
Gastroenterology & Hepatology
Fin S. Larsen, Faouzi Saliba
Summary: Acute liver failure (ALF) leads to numerous complications, resulting in multi-organ failure. This review focuses on the pathophysiological processes and management strategies using artificial liver support and liver transplantation (LT). The deterioration in ALF is caused by hyperammonemia and release of DAMPs, leading to hepatic encephalopathy, cerebral edema, and inflammatory activation. Continuous renal replacement therapy (CRRT) and plasma exchange are effective in removing ammonia and DAMPs. LT criteria for non-paracetamol cases are robust, but criteria for paracetamol-intoxicated patients are more unreliable. Post-LT survival rates have significantly improved, reaching 90% for patients needing LT for survival.
LIVER INTERNATIONAL
(2023)
Article
Medicine, General & Internal
Liyuan Long, Hai Li, Guohong Deng, Xianbo Wang, Sihong Lu, Beiling Li, Zhongji Meng, Yanhang Gao, Zhiping Qian, Feng Liu, Xiaobo Lu, Haotang Ren, Jia Shang, Hai Li, Shaoyang Wang, Yubao Zheng, Huadong Yan, Shan Yin, Wenting Tan, Qun Zhang, Xin Zheng, Jinjun Chen, Sen Luo, Jinming Zhao, Wei Yuan, Tao Li, Rongjiong Zheng, Junping Liu, Xiaoxiao Liu, Wenyi Gu, Sumeng Li, Xue Mei, Ruochan Chen, Yan Huang
Summary: Hepatic encephalopathy has a significant impact on adverse outcomes in patients with acute-on-chronic liver diseases, especially in those with grades 3-4 hepatic encephalopathy. Patients with alcohol consumption are more likely to develop hepatic encephalopathy compared to those with hepatitis B virus infection, and the impact of different grades of hepatic encephalopathy on adverse outcomes increases progressively.
FRONTIERS IN MEDICINE
(2021)
Review
Immunology
Zefeng Chen, Jingsheng Ruan, Dinghua Li, Min Wang, Zhiwei Han, Wenxia Qiu, Guobin Wu
Summary: Hepatic encephalopathy is a neurological disorder that occurs in patients with liver insufficiency, and its pathogenesis has not been fully elucidated. Pharmacotherapy is the main therapeutic option for HE, which targets the pathogenesis of HE by reducing ammonia levels, improving neurotransmitter signal transduction, and modulating intestinal microbiota. The intestinal microbiota is closely associated with multiple links in the pathogenesis of HE, and restoring the homeostasis of intestinal bacteria or providing specific probiotics has significant effects on neurological disorders in HE.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
Article
Food Science & Technology
Peng Liu, Heng Li, Hongyu Xu, Jinsong Gong, Min Jiang, Jianying Qian, Zhenghong Xu, Jinsong Shi
Summary: This study demonstrates that chitooligosaccharides (COS) have significant hepatoprotective, neuroprotective, and prebiotic effects, and they can prevent the progression of hepatic encephalopathy (HE). The protective effects of COS are mediated through the modulation of the gut-liver-brain axis, leading to improvements in cognitive function and inhibition of neuroinflammation and hepatitis.
MOLECULAR NUTRITION & FOOD RESEARCH
(2023)
Review
Gastroenterology & Hepatology
Dominique Thabut, Charlotte Bouzbib, Lucy Meunier, Manon Haas, Nicolas Weiss, Alexandre Louvet, Francois Imbert-Bismut, Fanny Mochel, Yann Nadjar, Antoine Santiago, Thierry Thevenot, Veronique Duhalde, Frederic Oberti, Claire Francoz, Audrey Coilly, Marie-Noelle Hilleret, Pascal Lebray, Amelie Liou-Schischmanoff, Louise Barbier, Christophe Duvoux, Georges-Philippe Pageaux, Michael Bismuth, Damien Galanaud, Thomas De Broucker, Jean-Francois Cadranel, Vincent Leroy, Vincent Di Martino, Dominique Larrey, Christophe Camus, Olivier Scatton, Victor De Ledinghen, Ariane Mallat, Marika Rudler, Christophe Bureau
Summary: Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease that often goes undiagnosed due to a lack of understanding and consensus on diagnosis. Non-specific symptoms and comorbidities in cirrhotic patients make differential diagnosis challenging. Guidelines are provided to assist clinicians in diagnosing and treating HE. Liver transplantation may be indicated for HE, but its reversibility post-transplantation and the consequences in patients with other neurological disorders remain controversial.
LIVER INTERNATIONAL
(2023)
Article
Biochemistry & Molecular Biology
Mariana Macedo de Oliveira, Alexis Monnet-Aimard, Cristina R. Bosoi, Melanie Tremblay, Christopher F. Rose
Summary: This study aimed to investigate the impact of sex on chronic liver disease (CLD), hepatic encephalopathy (HE), and muscle mass loss. The results showed that female bile-duct ligated (BDL) rats developed CLD and HE, but did not experience muscle loss, brain edema, and short-term memory impairment. Compared to male BDL rats, female BDL rats also did not exhibit systemic oxidative stress and decreased albumin levels. Furthermore, both female BDL rats and male BDL rats treated with an antioxidant were protected against ammonia-induced overt HE.
JOURNAL OF NEUROCHEMISTRY
(2022)
Review
Gastroenterology & Hepatology
Wouter Claeys, Lien Van Hoecke, Sander Lefere, Anja Geerts, Xavier Verhelst, Hans Van Vlierberghe, Helena Degroote, Lindsey Devisscher, Roosmarijn E. Vandenbroucke, Christophe Van Steenkiste
Summary: Hepatic encephalopathy (HE) is a neurological complication of liver dysfunction and portosystemic shunting, highly prevalent in cirrhosis patients and associated with poor outcomes. New insights into peripheral origins in HE have led to innovative treatments like fecal microbiota transplantation, but central nervous system perturbations have not been fully considered. This review proposes a holistic approach, describing HE as a global dysfunction of the neurogliovascular unit, impacting blood flow, nutrient supply, blood-brain barrier function, and leading to accumulation of neurotoxic substances. Taking a broader view of central nervous system alterations in liver disease could aid in further research into HE pathophysiology and development of specific therapeutic strategies targeting central nervous system damage.
Article
Gastroenterology & Hepatology
Vishal C. Patel, Sunjae Lee, Mark J. W. McPhail, Kevin Da Silva, Susie Guilly, Ane Zamalloa, Elizabeth Witherden, Sidsel Stoy, Godhev Kumar Manakkat Vijay, Nicolas Pons, Nathalie Galleron, Xaiohong Huang, Selin Gencer, Muireann Coen, Thomas Henry Tranah, Julia Alexis Wendon, Kenneth D. Bruce, Emmanuelle Le Chatelier, Stanislav Dusko Ehrlich, Lindsey Ann Edwards, Saeed Shoaie, Debbie Lindsay Shawcross
Summary: Rifaximin-alpha can alleviate hepatic encephalopathy and reduce the likelihood of infection by reducing systemic inflammation and promoting gut barrier repair.
JOURNAL OF HEPATOLOGY
(2022)
Review
Gastroenterology & Hepatology
Thomas H. Tranah, Victoria T. Kronsten, Debbie L. Shawcross
Summary: CAID is a condition characterized by immune dysfunction in patients with cirrhosis, resulting in impaired innate and adaptive immune responses. This dysfunction is driven by gut-barrier dysfunction and deficits in microbial compartmentalization, leading to systemic inflammation and exhaustion of immune cells. Understanding and addressing these immune dysregulations are crucial for improving patient outcomes and preventing complications in cirrhosis.
LIVER TRANSPLANTATION
(2022)
Editorial Material
Gastroenterology & Hepatology
Debbie L. Shawcross, Abid Suddle
LIVER TRANSPLANTATION
(2022)
Review
Gastroenterology & Hepatology
Charles E. Gallaher, Debbie L. Shawcross
Summary: Antimicrobial resistance is a major threat to global health, and its indiscriminate use has led to the emergence of multidrug-resistant bacteria. Patients with cirrhosis are at a higher risk of multidrug-resistant organism (MDRO) infections due to their frequent use of antibiotics, invasive procedures, and recurrent hospitalizations. This review explores the vulnerability of cirrhosis patients to MDRO infections, the impact of bacterial infections on disease progression, prevalence of MDROs, outcomes, fungal infections, antibiotics efficacy, and management approaches.
SEMINARS IN LIVER DISEASE
(2022)
Review
Gastroenterology & Hepatology
Victoria T. Kronsten, Thomas H. Tranah, Carmine Pariante, Debbie L. Shawcross
Summary: Depression and chronic liver disease (CLD) are significant contributors to disability, morbidity, and mortality. The high prevalence of depression in CLD patients may be linked to systemic inflammation, gut dysbiosis, and a dysfunctional gut-liver-brain axis.
JOURNAL OF HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Cesar Jimenez, Meritxell Ventura-Cots, Margarita Sala, Margalida Calafat, Montserrat Garcia-Retortillo, Isabel Cirera, Nuria Canete, German Soriano, Maria Poca, Macarena Simon-Talero, Jose Altamirano, Michael Lucey, Guadalupe Garcia-Tsao, Robert S. Brown, Robert F. Schwabe, Elizabeth C. Verna, Bernd Schnabl, Francisco Bosques-Padilla, Philippe Mathurin, Juan Caballeria, Alexandre Louvet, Debbie L. Shawcross, Juan G. Abraldes, Joan Genesca, Ramon Bataller, Victor Vargas
Summary: Rifaximin as an adjuvant treatment for alcoholic hepatitis can significantly reduce the number of infections and clinical complications, contributing to a lower incidence of acute-on-chronic liver failure and mortality.
LIVER INTERNATIONAL
(2022)
Letter
Gastroenterology & Hepatology
Thomas H. Tranah, Maria-Pilar Ballester, Juan Antonio Carbonell-Asins, Rajiv Jalan, Debbie L. Shawcross
JOURNAL OF HEPATOLOGY
(2023)
Article
Gastroenterology & Hepatology
Sara Montagnese, Pierre-Emmanuel Rautou, Manuel Romero-Gomez, Fin Stolze Larsen, Debbie L. Shawcross, Dominique Thabut, Hendrik Vilstrup, Karin Weissenborn
Summary: The EASL Clinical Practice Guidelines on the management of hepatic encephalopathy provide evidence-based answers to questions about its definition, diagnosis, differential diagnosis, and treatment. However, it does not cover the pathophysiology of hepatic encephalopathy or all available treatment options.
JOURNAL OF HEPATOLOGY
(2022)
Letter
Gastroenterology & Hepatology
Thomas H. Tranah, Maria-Pilar Ballester, Juan Antonio Carbonell-Asins, Rajiv Jalan, Debbie L. Shawcross
JOURNAL OF HEPATOLOGY
(2023)
Letter
Gastroenterology & Hepatology
Thomas H. Tranah, Maria-Pilar Ballester, Juan Antonio Carbonell-Asins, Rajiv Jalan, Debbie L. Shawcross
JOURNAL OF HEPATOLOGY
(2023)
Editorial Material
Gastroenterology & Hepatology
Debbie L. Shawcross, Florence Wong
AMERICAN JOURNAL OF GASTROENTEROLOGY
(2023)
Article
Gastroenterology & Hepatology
Richard J. Aspinall, Mark Hudson, Stephen D. Ryder, Paul Richardson, Elizabeth Farrington, Mark Wright, Robert T. Przemioslo, Francisco Perez, Melanie Kent, Roland Henrar, Joe Hickey, Debbie L. Shawcross
Summary: In clinical practice in the UK, the use of RFX in patients with HE was associated with a 35% survival rate, high treatment adherence, 76% transplant-free survival rate, minimal healthcare resource utilization, and low rates of complications at 5 years post-initiation.
FRONTLINE GASTROENTEROLOGY
(2023)
Editorial Material
Gastroenterology & Hepatology
Debbie L. Shawcross, Dominique Thabut, Piero Amodio
JOURNAL OF HEPATOLOGY
(2023)
Letter
Gastroenterology & Hepatology
Thomas H. Tranah, Maria-Pilar Ballester, Juan Antonio Carbonell-Asins, Rajiv Jalan, Debbie L. Shawcross
JOURNAL OF HEPATOLOGY
(2023)
Review
Infectious Diseases
Blair Merrick, Chrysi Sergaki, Lindsey Edwards, David L. Moyes, Michael Kertanegara, Desiree Prossomariti, Debbie L. Shawcross, Simon D. Goldenberg
Summary: Antimicrobial resistance (AMR) presents a significant burden to the global healthcare system, particularly in Gram-negative organisms such as extended-spectrum beta-lactamase and carbapenemase-producing Enterobacterales (ESBL and CPE). These pathogens have limited treatment options, leading to poor clinical outcomes. Manipulating the gut microbiota through various methods, including diet, probiotics, bacteriophages, and fecal microbiota transplantation (FMT), can effectively restore colonization resistance and limit the spread of AMR organisms.
INFECTIOUS DISEASE REPORTS
(2023)