Prévalence et caractérisation de la cytolyse hépatique des sujets âgés de plus de 75 ans (étude prospective (février 2008 à février 2009) sur 350 patients adressés en court séjour gériatrique à l'hôpital René-Muret)

Introduction: les données épidémiologiques concernant la cytolyse hépatique des sujets âgés de plus de 75 ans sont inconnues alors que la proportion de cette tranche de population s'accroit. But: déterminer la prévalence et les étiologies de cytolyse hépatique dans une population gériatrique. Méthode: un dosage systématique des transaminases était fait chez 350 patients âgés d'au moins 75 ans hospitalisés entre février 2008 et février 2009 dans un service de court séjour gériatrique. Tous les cas de cytolyse étaient confirmés par un deuxième prélèvement à 72h. Une enquête étiologique était faite pour les cas de cytolyse. Résultats: quatre pour cent (n=14) de cytolyse hépatique était observé (13 cas d'ALAT < ION, 5 maladies alcooliques du foie, 2 lithiases résiduelles de la voie biliaire principale, 2 cytolyses médicamenteuses, 1 foie cardiaque, 1 hépatite virale C, 1 cirrhose biliaire primitive, 1 cas de métastases hépatiques et 1 perdu de vue). Un tiers des patients avec cytolyse (n=4) avaient un syndrome métabolique. Aucun cas de NASH n'était retrouvé. Deux tiers des patients étaient issus de services d'urgence. Conclusion: cette étude prospective retrouve une prévalence faible mais non négligeable de cytolyse hépatique dans une population de sujets âgés, sélectionnée encourageant au dosage systématique des transaminases chez les sujets âgés. De nouvelles études sont nécessaires à plus grande échelle afin de mieux caractériser la cytolyse hépatique des sujets âgés de plus de 75 ans et d'évaluer l'intérêt diagnostique et thérapeutique de la mesure non invasive de fibrose hépatique par Hbroscan".PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Histoire naturelle du carcinome hépatocellulaire sur cirrhose (dépistage, facteurs prédictifs et facteurs pronostiques)

Le carcinome hépatocellulaire est un problème majeur de santé publique car son incidence et sa mortalité sont croissantes. Compte tenu du pourcentage encore trop faible de malades éligibles pour un traitement curatif, la stratégie s'oriente vers une prise en charge en amont la plus précoce possible. Cette stratégie se fonde essentiellement sur le dépistage et sur l'identification de facteurs prédictifs de survenue du carcinome hépatocellulaire chez les malades atteints de cirrhose : - En ce qui concerne le dépistage, un travail a évalué son efficacité chez des malades caucasiens et un second a décrit les pratiques actuelles en France. - En ce qui concerne l'identification de facteurs prédictifs, cinq travaux sont présentés. Deux publications supplémentaires concernent le pronostic du carcinome hépatocellulaireLYON1-BU.Sciences (692662101) / SudocSudocFranceF

TM6F2-T and PNPLA3-G genetic variants co-modulate the risk of hepatocellular carcinoma in caucasian patients with alcoholic cirrhosis. Inter-cohort validation in 1068 patients.

0info:eu-repo/semantics/publishe

Hepatic nodular lymphoid lesion with increased IgG4-positive plasma cells associated with primary biliary cirrhosis: a report of two cases

International audienceThe nodular lymphoid lesion of the liver known as reactive lymphoid hyperplasia or pseudolymphoma is rare and its pathogenesis is unknown. We report two cases of nodular lymphoid lesions of the liver with numerous IgG4-positive plasma cells in patients with primary biliary cirrhosis. Histologically, in both cases, the lesion showed a dense lymphoplasmacytic infiltrate with lymphoid follicles and granulomas. Fibrous tissue was scarce and without a storiform pattern. Obliterative phlebitis was not identified. The IgG4+ plasma cell counts were 82 and 76 per high power field, with an IgG4/IgG ratio of 75 and 64 %, respectively, which qualifies the lesions according to the diagnostic criteria for IgG4-related disease as « probable histological feature of IgG4-related disease ». There were no rearrangements of immunoglobulin heavy-chain genes and plasma cells had a polytypic pattern of kappa and lambda light-chain expression. The non-tumor liver showed primary biliary cirrhosis with destructive cholangitis without IgG4 plasma cells. In both cases, IgG4-related disease was not found in other organs neither at the time of diagnosis nor 3 years later. Serum IgG4 levels normalized after local ablation of the lesions. It seems unlikely that these lesions are a manifestation of IgG4-related disease. However, because the pathogenesis of both nodular lymphoid lesions and IgG4-related disease remains unclear, further studies are needed to elucidate a potential link between nodular lymphoid lesions of the liver and an increased number of IgG4 plasma cells. More definite conclusions will be possible when the pathogenesis of IgG4-related disease has been clarified

Manganese Superoxide Dismutase Dimorphism and Iron Overload, Hepatocellular Carcinoma, and Death in Hepatitis C Virus–Infected Patients

International audienc

PNPLA3 (rs738409 C>G) is a common risk variant associated with hepatocellular carcinoma in alcoholic cirrhosis.

LetterFLWINSCOPUS: le.jinfo:eu-repo/semantics/publishe

Non-invasive diagnosis and follow-up of autoimmune hepatitis

International audienceAutoimmune hepatitis (AIH) is a liver disease characterised by necrotico-inflammatory lesions of hepatocytes, the presence of specific autoantibodies and response to corticosteroid treatment. AIH must be considered in any patient with acute or chronic liver disease. As there is no pathognomonic sign of AIH, the diagnosis is based on a combination of clinical, biological, immunological and histological findings, after excluding other causes of liver disease. The clinical and biological presentation of AIH is variable and AIH can be associated with an autoimmune biliary disease, primary biliary cholangitis or primary sclerosing cholangitis in an overlap syndrome. For these reasons, diagnosis of AIH can be challenging. Even if liver histology remains essential in the diagnosis of AIH, non-invasive tests can be used at different steps of the management of AIH: diagnosis of AIH, notably diagnosis of an overlap syndrome, assessment of severity of AIH, searching for extra-hepatic disease frequently associated to AIH, evaluation of response to therapy, decision of treatment withdrawal. This review aims to provide practical guidelines for the use of non-invasive tests for the diagnosis and the follow-up of AIH. (C) 2021 Published by Elsevier Masson SAS

Liver iron, HFE gene mutations, and hepatocellular carcinoma occurrence in patients with cirrhosis.

International audienceBACKGROUND & AIMS: The influence of HFE gene mutations and liver iron overload on hepatocellular carcinoma (HCC) occurrence in patients with cirrhosis is subjected to controversial results. The aim of this work was to clarify this influence in a large cohort of prospectively followed-up cirrhotic patients classified according to the cause of their liver disease. METHODS: Three hundred one consecutive cirrhotic patients (162 alcoholics and 139 HCV-infected patients) were included at time of diagnosis of cirrhosis and followed-up. Liver iron overload on initial biopsy according to modified Deugnier's score and C282Y/H63D HFE gene mutations were assessed. RESULTS: In patients with alcoholic cirrhosis (mean iron score, 2.0 +/- 3.0; mean time of follow-up, 66.1 +/- 45.1 months), 40 (24.6%) developed HCC. Thirteen (8.02%) were heterozygotes for C282Y HFE gene mutation and had higher hepatic iron scores (3.6 +/- 3.8 vs 1.9 +/- 2.8, respectively, P = .05). In univariate analysis, liver iron overload as a continuous variable (HR, 1.23 [1.13-1.34], P /=2.0 (HR, 4.1 [2.1-7.3], P < .0001) and C282Y mutation carriage (HR, 2.7 [1.2-6.3], P = .01) were risk factors for HCC. In multivariate analysis, liver iron and C282Y mutation carriage remained independent risk factors for HCC. In patients with HCV-related cirrhosis (C282Y mutation carriage, 17 [12.23%]; mean liver iron score, 0.9 +/- 1.9; mean time of follow-up, 85.5 +/- 42.1 months; HCC, 63 [45.32%] patients), C282Y mutation carriage and liver iron were not associated with HCC occurrence. CONCLUSIONS: Liver iron overload and C282Y mutation are associated with a higher risk of HCC in patients with alcoholic but not HCV-related cirrhosis

Eating patterns in patients with compensated cirrhosis: A case-control study

Background: There is growing evidence suggesting that maintaining an adequate nutritional status for patients with liver cirrhosis (LC) is relevant to prevent complications. The present study aimed to describe dietary behaviours of patients with compensated and non-complicated LC and comparing them with those of subjects from the general population. Methods: In this case-control study, patients were volunteers enrolled in the ALICIR (ALImentation et CIRrhose) study, an observational survey nested in two French prospective cohorts of patients with biopsy-proven compensated cirrhosis related either to excessive alcohol consumption (CIRRAL) or to hepatitis B or C virus infection (CirVir). Controls were selected from the NutriNet-Sante cohort. Dietary data were collected through a semi quantitative food frequency questionnaire. Dietary and nutritional data were compared using multi-adjusted paired Student's tests. Results: Between June 2014 and February 2016, 174 patients of CirVir (N = 97) or CIRRAL (N = 77) were matched with 348 controls from the NutriNet-Santé cohort, according to gender, age, BMI and educational level. Compared to controls, patients (mean ± SD) consumed more sodas (236.0 ± 29.8 mL vs. 83.0 ± 33.0 mL) and water (1787.6 ± 80.6 mL vs. 933.6 ± 85.3 mL), and lower amounts of salty snacks (4.2 ± 1.42 g vs. 9.0 ± 1.6 g) and alcoholic beverages (71.8 ± 23.4 g vs. 151.2 ± 25.9 g), with all p values < 0.0001. Dietary behaviours differed according to LC aetiology. Conclusions: Dietary behaviour of patients significantly differed from subjects from the general population

Practice guidelines Non-invasive diagnosis and follow-up of primary sclerosing cholangitis

International audiencePrimary sclerosing cholangitis (PSC) is a rare and chronic cholestatic liver disease of unknown cause commonly associated with inflammatory bowel disease (IBD) and characterized by progressive obliterative fibro-inflammation of the biliary tree. Although the natural course is highly variable, PSC is often progressive, leading to biliary cirrhosis and its complications. In addition, PSC is a condition harbouring broad neoplastic potential with increased susceptibility for the development of both biliary and colon cancer. As in other chronic liver diseases, non-invasive methods play a major role in the diagnosis and monitoring of PSC. MR cholangiography is the key exam for the diagnosis and has replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP). A strict and standardised protocol for carrying out MR cholangiography is recommended. Liver stiffness measured by FibroScan (R) correlates with the degree of liver fibrosis, has a prognostic value and should be repeated during follow-up. Invasive methods still play an important role, especially ERCP which is indicated for therapeutic purposes or for endo-biliary sample collection in suspected cholangiocarcinoma (following discussion in a multidisciplinary team meeting) and total colonoscopy which is recommended at the initial diagnosis of any PSC and annually in patients with IBD. (c) 2021 Elsevier Masson SAS. All rights reserved. .101775 SAS. All rights reserved