Spleen Stiffness Probability Index (SSPI): A simple and accurate method to detect esophageal varices in patients with compensated liver cirrhosis.

Abstract Introduction and objectives Recent findings pointed out that even low-risk esophageal varices (EVs) are markers of severe prognosis. Accordingly, we analyzed spleen stiffness (SS) as a non-invasive method to predict EVs of any grade in a cohort of patients with compensated liver cirrhosis. Method We measured SS and liver stiffness (LS) using point-Shear-Wave Elastography (pSWE) with Philips Affiniti 70 system in 210 cirrhotic patients who had undergone endoscopic screening for EVs. We compared SS and LS predictive capability for EVs of any grade. Results SS was higher in cirrhotic patients with EVs if compared to patients without EVs (p Conclusion SS showed significantly higher performance than other parameters, proving to be the best non-invasive test in the screening of EVs: by directly applying SS cut-off of 31 kPa, our department could have safely avoided endoscopy in 36% of patients. Despite cut-off analyses, it was possible to create a probability model that could further stratify low-risk from high-risk patients (for any grade of EVs)

Adverse reactions of direct-acting antiviral agents in HCV patients: Our experience

Background and Aims: Direct-acting Antiviral Agents (DAAs) have shown a high rate of Sustained Virologic Response (SVR) in the treatment of hepatitis C, with few and mild adverse reactions. The aim of this study was to evaluate: (1) The efficacy of DAAs; (2) The incidence of adverse reactions; (3) The interactions with other drugs in our centre. Method: We performed an observational study of all HCV patients treated with DAAs in our centre from 01/01/2015 to 01/08/2017. We recorded: patient demographic information, grade of fibrosis by point-ShearWave Elastography on Philips IU22 before and 12 months after treatment, HCV genotype, DAAs adverse reactions and therapeutic scheme, and concomitant drugs. Results: We treated 142 HCV consecutive patients with second generation DAAs. We obtained a Sustained Virologic Response at 12 weeks (SVR12) in 93.5% of patients, 9 failures and 3 treatment interruptions due to adverse effects. Only 3 patients did not showany adverse reaction. In almost half of the cases fatigue and a reduction of at least 2 g/dL of haemoglobin levels were observed. Another frequent adverse effect was hyperglycemia (31.7%), observed in around 70% of the patients with type 2 diabetes treated with insulin or oral hypoglicemic agents and only in 25% of the non-diabetic patients. Hyperglycemia was more frequent in patients taking Daclatasvir + Sofosbuvir (45.7% vs 31.7% \u2013 p < 0.001) without a correlation with a specific antidiabetic drugs. Moreover, higher degrees of fibrosis were associated with a higher number of adverse reactions (p < 0.001). Patients who take Ribavirin display a high rate of anaemia also present with only DAA, even if less severe (67% vs 28% \u2013 p < 0.001). Conclusion: In this real life study, DAAs confirmed the excellent therapeutic success already known in literature. However,we found a higher rate of adverse effects especially in more advanced liver disease. In particular we have noticed a relevant rate of hyperglycemia, an adverse effect that has not been reported in literature and that appears to be related to the drug\u2019s class or the hepatic effect of HCV clearance rather than drug-drug interactions

The role of elastography in alcoholic liver disease: fibrosis staging and confounding factors, a review of the current literature

INTRODUCTION: Alcohol-related liver disease (ALD) was estimated to have a prevalence of 2% among the USA population. Since severe fibrosis in compensated patients is the main predictor of long-term survival, it is of utmost importance to early detect patients with severe fibrosis before decompensation occurs. Liver elastography has been used to stage liver fibrosis. However, there is a widespread lack in guidelines for the correct use of liver stiffness (LS) in ALD. EVIDENCE ACQUISITION: A structured search was carried out on MEDLINE/PubMed database. From the original 225 research articles identified, only 12 studies met the inclusion criteria, with 10 studies being eventually included. EVIDENCE SYNTHESIS: According to reported data, patients with aspartate aminotransferase (AST)>100 IU/L and 50 IU/L showed significantly higher values of LS if compared to patients with the same fibrosis stage. Also, excessive alcohol consumption greatly influences elastography, leading to false fibrosis staging. When LS values >5-6 kPa are detected, several aspects should be taken into account. First of all, the patient should be asked about the current alcohol consumption (i.e. active vs. abstinence, determination of abstinence period, and quantification of alcohol intake), and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. and if the patient is an active drinker, liver elastography can be repeated after a complete abstinence period of at least two weeks. Secondly, clinicians should check liver transaminases level, and if AST are above 100 IU/L, they should be aware of a possible overestimation of fibrosis. However, whether transaminases-adapted cut-off values should be used for ad-hoc decisions in patients with no time or option to withdraw from alcohol consumption is still a matter of debate. CONCLUSIONS: We hope that our review article may serve as a reference point in the prospect of futures guidelines