Article
Gastroenterology & Hepatology
Jasmohan S. Bajaj, Marcela Pena-Rodriguez, Alex La Reau, Wendy Phillips, Michael Fuchs, Brian C. Davis, Richard K. Sterling, Masoumeh Sikaroodi, Andrew Fagan, Amirhossein Shamsaddini, Zachariah Henseler, Tonya Ward, Puneet Puri, Hannah Lee, Patrick M. Gillevet
Summary: Longitudinal study on cirrhosis outpatients showed that the greatest changes in transkingdom gut microbial interactions occurred during the first decompensation, compared to subsequent decompensating events. A transkingdom approach may improve prediction and provide therapeutic targets for preventing cirrhosis progression.
Article
Biochemistry & Molecular Biology
Antonio Gil-Gomez, Angela Rojas, Maria R. Garcia-Lozano, Rocio Munoz-Hernandez, Rocio Gallego-Duran, Douglas Maya-Miles, Rocio Montero-Vallejo, Sheila Gato, Javier Gallego, Ruben Frances, German Soriano, Javier Ampuero, Manuel Romero-Gomez
Summary: In patients with cirrhosis carrying the HSD17B13 gene variant rs72613567:TA, there is an increased risk of hepatic decompensation and death.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Gastroenterology & Hepatology
Marika Rudler, Virginia Hernandez-Gea, Bogdan Dumitru Procopet, Alvaro Giraldez, Lucio Amitrano, Candid Villanueva, Luis Ibanez, Gilberto Silva-Junior, Joan Genesca, Christophe Bureau, Jonel Trebicka, Rafael Banares, Aleksander Krag, Elba Llop, Wim Laleman, Jose Maria Palazon, Jose Castellote, Susana Rodrigues, Lise Lotte Gluud, Carlos Noronha Ferreira, Nouria Canete, Manuel Rodriguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Gronbaek, Manuel Hernandez-Guerra, Romano Sassatelli, Alessandra Dell'era, Marco Senzolo, Juan G. Abraldes, Manuel Romero-Gomez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Helene Larrue, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Remy Schwarzer, Christian Jansen, Marie-Angele Robic, Irene Conejo, Javier Martinez Gonzalez, Maria Vega Catalina, Agustin Albillos, Edilmar Alvarado, Maria Anna Guardascione, Maxime Mallet, Simona Tripon, Georgina Casanovas, Jaume Bosch, Juan-Carlos Garcia-Pagan, Dominique Thabut
Summary: pTIPS is more effective in improving survival compared to endoscopic treatment for high-risk patients with cirrhosis and variceal bleeding. HE at admission does not affect the efficacy of pTIPS.
Article
Gastroenterology & Hepatology
Faiz Afridi, Anmol Mittal, Nikolaos Pyrsopoulos
Summary: This study analyzed the inpatient mortality rates and hospitalization charges associated with cirrhotic decompensation from esophageal variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome from 2007 to 2017. The results showed a decrease in mortality rates and lengths of stay for all types of decompensations, while hospitalization charges increased. The study also found that patient age increased and a higher proportion of patients were White and had the ability to pay.
JOURNAL OF CLINICAL GASTROENTEROLOGY
(2023)
Article
Infectious Diseases
Caterina Zoratti, Rita Moretti, Lisa Rebuzzi, Irma Valeria Albergati, Antonietta Di Somma, Giuliana Decorti, Stefano Di Bella, Lory Saveria Croce, Mauro Giuffre
Summary: This narrative review aims to provide physicians with basic and practical knowledge for efficiently choosing the best antibiotic therapy in patients with liver cirrhosis and ongoing infections.
Review
Gastroenterology & Hepatology
Rajiv Jalan, Gennaro D'Amico, Jonel Trebicka, Richard Moreau, Paolo Angeli, Vicente Arroyo
Summary: Traditionally, complications of cirrhosis were thought to be primarily caused by circulatory dysfunction due to portal hypertension; however, recent studies have shown that systemic inflammation and organ immunopathology play crucial roles in organ dysfunction in cirrhosis, impacting various organ systems. The interaction between traditional and emerging concepts in the initiation and maintenance of organ dysfunction in cirrhosis is a topic of great interest for future research.
JOURNAL OF HEPATOLOGY
(2021)
Article
Gastroenterology & Hepatology
Sanchit Sharma, Samagra Agarwal, Deepak Madhu, Randeep Rana, Anany Gupta, Srikanth Gopi, Deepak Gunjan, Anoop Saraya
Summary: This study compared the long-term outcomes of patients with cirrhosis with gastric variceal bleeding and esophageal variceal bleeding. It found that rebleeding was more predominant in patients with gastric variceal bleeding, while ascites was the most significant event in patients with esophageal variceal bleeding.
HEPATOLOGY INTERNATIONAL
(2023)
Article
Gastroenterology & Hepatology
Catherine Frenette, Zeid Kayali, Edward Mena, Parvez S. Mantry, Kathryn J. Lucas, Guy Neff, Miguel Rodriguez, Paul J. Thuluvath, Ethan Weinberg, Bal R. Bhandari, James Robinson, Nicole Wedick, Jean L. Chan, David T. Hagerty, Kris Kowdley
Summary: Emricasan was found to be safe but ineffective in treating decompensated NASH cirrhosis in a double-blind, placebo-controlled study with 217 participants. This study may provide guidance for future clinical trials in patients with decompensated cirrhosis related to non-alcoholic steatohepatitis.
JOURNAL OF HEPATOLOGY
(2021)
Review
Gastroenterology & Hepatology
Ki Tae Yoon, Hongqun Liu, Samuel S. Lee
Summary: NSBB therapy in cirrhotic patients is effective in preventing bleeding, but may have detrimental effects in decompensated cirrhosis. While some studies suggest harmful effects of NSBBs, overall, using beta-blockers in cirrhosis seems to outweigh the risks and provide more benefits.
CLINICAL AND MOLECULAR HEPATOLOGY
(2021)
Article
Gastroenterology & Hepatology
Elliot B. Tapper, Zhe Zhao, G. Scott Winder, Neehar D. Parikh
Summary: Deprescribing benzodiazepines in patients with cirrhosis may reduce the risk of falls and fractures but does not improve survival or liver health.
Article
Medicine, General & Internal
Silvia Wuerstle, Alexander Hapfelmeier, Siranush Karapetyan, Fabian Studen, Andriana Isaakidou, Tillman Schneider, Roland M. Schmid, Stefan von Delius, Felix Gundling, Rainer Burgkart, Andreas Obermeier, Ulrich Mayr, Marc Ringelhan, Sebastian Rasch, Tobias Lahmer, Fabian Geisler, Paul E. Turner, Benjamin K. Chan, Christoph D. Spinner, Jochen Schneider
Summary: Ascitic fluid infection is a serious complication of liver cirrhosis, and it is crucial to distinguish between spontaneous bacterial peritonitis (SBP) and secondary peritonitis in these patients due to different treatment approaches. This study analyzed 532 SBP episodes and 37 secondary peritonitis episodes to identify key differentiation criteria. Microbiological characteristics, severity of illness, and clinicopathological parameters were identified as the most important predictors to distinguish between SBP and secondary peritonitis. A point-score model with ten discriminatory features was established, and two cut-off scores were defined to divide patients into low-risk and high-risk groups for secondary peritonitis based on a sensitivity of 95% to rule out or rule in SBP episodes. Overall, the discrimination between secondary peritonitis and SBP remains challenging, but the findings of this study may help clinicians with the crucial differentiation.
Article
Medicine, General & Internal
Piotr F. Czempik, Michal P. Pluta, Mariusz Hofman, Piotr S. Liberski, Tomasz Jaworski, Anna Szczepanska, Oskar Bozek
Summary: A 54-year-old male with impaired consciousness was admitted to the ICU. His medical history included alcohol dependence, liver cirrhosis, esophageal varices, previous banding procedures, and obesity. Imaging tests initially showed no abnormalities, but an urgent esophagogastroduodenoscopy revealed esophageal varices and scarification. Further investigations including neurologic assessment and MRI led to a diagnosis of hepatic encephalopathy. CT of the abdomen confirmed the diagnosis by showing intussusception of the ileum.
Article
Gastroenterology & Hepatology
Liu Chuan, Cao Zhujun, Yan Huadong, Wong Yu Jun, Xie Qing, Masashi Hirooka, Hirayuki Enomoto, Tae Hyung Kim, Amr Shaaban Hanafy, Liu Yanna, Huang Yifei, Li Xiaoguo, Kang Ning, Yohei Koizumi, Yoichi Hiasa, Takashi Nishimura, Hiroko Iijima, Young Kul Jung, Hyung Joon Yim, Guo Ying, Zhang Linpeng, Ma Jianzhong, Manoj Kumar, Ankur Jindal, Kok Ban Teh, Shiv Kumar Sarin, Qi Xiaolong
Summary: This study developed a new score (SAVE score) that accurately predicts the risk of hepatic decompensation in cACLD patients and also accurately predicts clinically significant portal hypertension.
AMERICAN JOURNAL OF GASTROENTEROLOGY
(2022)
Review
Gastroenterology & Hepatology
Veeral Ajmera, Beom Kyung Kim, Kun Yang, Abdul M. Majzoub, Tarek Nayfeh, Nobuharu Tamaki, Namiki Izumi, Atsushi Nakajima, Ramazan Idilman, Mesut Gumussoy, Digdem Kuru Oz, Ayse Erden, Natalie E. Quach, Xin Tu, Xinlian Zhang, Mazen Noureddin, Alina M. Allen, Rohit Loomba
Summary: Liver stiffness assessed by magnetic resonance elastography (MRE) is associated with liver-related events, and the combination of MRE and Fibrosis-4 has excellent negative predictive value for hepatic decompensation.
Article
Health Care Sciences & Services
Chathur Acharya, Tejasav S. Sehrawat, Deborah B. McGuire, Jawaid Shaw, Andrew Fagan, Sara McGeorge, Amy Olofson, Melanie B. White, Edith Gavis, Patrick S. Kamath, Lori Bergstrom, Jasmohan Singh Bajaj
Summary: The study found that male patients with cirrhosis, gastrointestinal bleeding, or hepatic encephalopathy, without opioid use or alcohol-related etiologies, were more likely to participate in health IT interventions. Caregiver reluctance, perceived burden, and technology-related issues were major factors leading to refusal to participate.
JOURNAL OF MEDICAL INTERNET RESEARCH
(2021)
Article
Medicine, General & Internal
Jeanne E. Conner, Joshua A. Steinberg
Summary: Diagnosis of anaphylaxis should involve comprehensive consideration, including detailed history and objective findings. Using diagnostic criteria and considering rare triggers, as well as evaluating for mast cell disorders, can aid in the diagnosis. Referral to specialists may be necessary.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Alejandra Escobar Vasco, Julie -Ann Talano, Larisa Broglie
Summary: HLH is a rare but fatal disease, and maintaining a high level of suspicion is crucial for patients with evidence of hyperinflammation. Adolescents with HLH should undergo genetic evaluation for familial HLH, and primary immune deficiencies and dysregulation disorders should also be considered. Early diagnosis and treatment are necessary to prevent morbidity and mortality related to HLH's hyperinflammation.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Kathleen Ryan
Summary: Fevers of unknown origin (FUO) present a diagnostic challenge, with a wide range of potential causes including infectious, autoimmune, and malignant. Some adolescents with FUO may never have an identifiable etiology, but the prognosis is generally favorable in the absence of red flag symptoms.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Brett J. Bordini, Ryan D. Walsh, Donald Basel, Tejaswini Deshmukh
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Hsi Yen, Leah Lalor
Summary: The article emphasizes the importance of increased awareness among healthcare providers when faced with severe adolescent acne that may not be typical teenage acne. It provides a summary of uncommon causes of severe adolescent acne and a simplified diagnostic approach. Additionally, it discusses rare autoinflammatory syndromic causes of acne and acne associated with excess androgen states.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Bethany Auble, Justin Dey
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Kaitlin V. Kirkpatrick, James J. Nocton
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Louella Amos
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Tracey Thompson, Ashley Phimister, Alexander Raskin
Summary: Heart failure occurs as a result of pressure or volume overload in congenital and acquired heart diseases, and its treatment varies depending on the underlying cause.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Allison Remiker, Kristina Bolling, James Verbsky
Summary: CVID is a heterogeneous group of disorders characterized by abnormal B-cell differentiation and impaired production of specific immunoglobulin. Clinical manifestations vary and include recurrent bacterial infections, lymphoproliferation, autoimmunity, pulmonary disease, gastrointestinal disease, granulomas, and increased cancer risk. The diagnosis of CVID is complex, requiring exclusion of other causes of immunoglobulin deficiency and assessment based on clinical criteria models. Treatment involves regular immunoglobulin replacement therapy, infection prevention, and surveillance for complications.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Bridget A. Rafferty, Pooja Thakrar
Summary: CNO/CRMO is an underrecognized autoinflammatory disorder of the skeletal system resulting from immune dysregulation. Diagnosis is often delayed due to vague symptoms and the lack of accepted diagnostic criteria or specific biomarkers. Untreated CRMO can lead to chronic skeletal deformities, arthritis, and chronic pain. Diagnosis requires MRI and WB-MRI. Treatment primarily involves antiinflammatory medications.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Vaishali Singh, Scott K. Van Why
Summary: Hypertension in adolescents is rare, and evaluation for identifiable causes beyond primary hypertension is necessary. Common causes of hypertension in this age group are usually acquired or congenital renal or vascular diseases. If these etiologies are not found, exploration for rare causes, including monogenic hypertension, should be pursued.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Dominic O. Co
Summary: Acquired demyelinating syndromes (ADS) are a group of inflammatory demyelinating conditions that include optic neuritis, transverse myelitis, and acute demyelinating encephalomyelitis. Differentiating between subtypes of ADS is important for optimal patient management, and this can be achieved by considering clinical features, laboratory tests (especially autoantibodies), and MRI findings.
MEDICAL CLINICS OF NORTH AMERICA
(2024)
Article
Medicine, General & Internal
Meghan K. Konda, Matthew Harmelink
Summary: Pediatric adolescent muscle weakness can have various causes. A methodical diagnostic evaluation is necessary to determine the specific disease category, which may require specialized care or extensive testing. The ultimate diagnosis is crucial for prognostication.
MEDICAL CLINICS OF NORTH AMERICA
(2024)