Frequency of significant fibrosis in various chronic liver diseases: an evaluation with Transient Elastography (TE)

INTRODUCTION: Liver biopsy has long been the gold standard to evaluate liver fibrosis. TE was developed as a non- invasive method to assess liver fibrosis by measuring liver stiffness using shear wave velocity. Many studies have proven its’ effectiveness as a method for evaluating liver fibrosis.1-2 The use of TE in UMMC began in 2013. OBJECTIVE: To determine the frequency and aetiology of liver fibrosis and cirrhosis in our local population METHOD: This was a retrospective study conducted at UMMC. Inclusion criteria was all patients who had TE performed from 1 January 2013 to 31 December 2021. Their demographics, clinical characteristics and TE findings were charted. RESULTS: A total of 3066 patients were included, in which 51.7% were males and 48.3% were females. The median CAP value was 271 dB/m. The median E value was 6.5kPa. 11.2% and 11.3% of patients had significant fibrosis (10.1-14.9kPa) and cirrhosis(≥15kPa) respectively. Non-alcoholic fatty liver disease (NAFLD) was noted to be the most common aetiology for fibrosis (32.8%), followed by chronic hepatitis B (CHB) at 25.2%, chronic hepatitis C (CHC) at 6.7% and alcoholic liver disease (ALD) with 1.3%. This finding was also found to be similar in the cirrhosis group (NAFLD 32.5%, CHB 17.2%, CHC 11.9% and ALD 1.4%). 219 DISCUSSION: Our study shows that the most common cause for significant fibrosis and cirrhosis is NAFLD. This is in contrast with previous studies, that reported the most common aetiology being CHB.3-4 This is likely due to the availability of effective treatment for hepatitis B and C. This may also be attributed to the initiation of the national Hepatitis B vaccination program for newborns and the improvement in blood transfusion safety. CONCLUSION: NAFLD has the greatest frequency of fibrosis compared with other aetiologies of liver disease - mainly as there is no effective treatment, unlike viral hepatitis

Frequency of significant steatosis in various chronic liver diseases: an evaluation with Transient Elastography (TE)

INTRODUCTION: TE was developed as a non-invasive method to assess liver fibrosis and steatosis using shear wave velocity. Many studies have proven its’ effectiveness as a method for evaluating liver fibrosis and steatosis.1-2 OBJECTIVE: To determine the prevalence and aetiology of steatosis in our local population. METHOD: This study was conducted as a retrospective review on all patients who had TE performed at UMMC from 1 January 2013 to 31 December 2021. Their demographics, clinical characteristics and TE findings were charted. RESULTS: A total of 3066 patients were included. 51.7% were males and 48.3% were females. The median CAP value was 271 dB/m. The median E value was 6.5kPa. 61.2% of patients had steatosis, with a staggering number of of these patients having significant steatosis (51.8%). 6.3% of patients had S2 steatosis whereas 45.5% of patients had severe (S3) steatosis. Interestingly, in those with S2 steatosis, 34.7% had chronic hepatitis B (CHB), 31.5% had non-alcoholic fatty liver disease (NAFLD), 5.2% with chronic hepatitis C (CHC) and 1% had alcoholic liver disease (ALD). In the S3 steatosis group, 66.7% had NAFLD, followed by ALD (36.6%), CHB (30.1%) and CHC (27.7%). 221 DISCUSSION: It is important to highlight that a large proportion of our patients has significant steatosis. This is likely in keeping with the global rise of obesity and sedentary lifestyle.3 NAFLD is a 4-decades old nomenclature that does not appropriately address the heterogenous pathogenicity of fatty liver disease. Our study reflects this heterogeneity, as it shows that steatosis often co-exists with other diverse aetiologies. CONCLUSION: Whilst NAFLD clearly has the greatest frequency of severe steatosis, it is also present in other aetiologies. These findings support the new terminology of metabolic associated fatty liver disease (MAFLD), which reflects the fact that NAFLD commonly co-exists with other aetiologies

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the latest term for steatotic liver disease associated with metabolic syndrome. MASLD is the most common cause of chronic liver disease and is the leading cause of liver-related morbidity and mortality. It is important that all stakeholders be involved in tackling the public health threat of obesity and obesity-related diseases, including MASLD. A simple and clear assessment and referral pathway using non-invasive tests is essential to ensure that patients with severe MASLD are identified and referred to specialist care, while patients with less severe disease remain in primary care, where they are best managed. While lifestyle intervention is the cornerstone of the management of patients with MASLD, cardiovascular disease risk must be properly assessed and managed because cardiovascular disease is the leading cause of mortality. No pharmacological agent has been approved for the treatment of MASLD, but novel anti-hyperglycemic drugs appear to have benefit. Medications used for the treatment of diabetes and other metabolic conditions may need to be adjusted as liver disease progresses to cirrhosis, especially decompensated cirrhosis. Based on non-invasive tests, the concepts of compensated advanced chronic liver disease and clinically significant portal hypertension provide a practical approach to stratifying patients according to the risk of liver-related complications and can help manage such patients. Finally, prevention and management of sarcopenia should be considered in the management of patients with MASLD

Changing landscape of liver cirrhosis in multi-racial Asian country: a decade comparison

BACKGROUND AND AIM: Chronic viral hepatitis B infection was the most common cause of liver cirrhosis in Asian countries, however with the rising prevalence of obesity and implementation of prevention strategies for viral hepatitis B transmission, we predict that there is a change in the epidemiology of liver cirrhosis. Our aim is to determine the change in epidemiology of liver cirrhosis and hepatocellular carcinoma in our centre. METHODS: A cross sectional study was conducted where we recruited all liver cirrhosis patients who were attending inpatient and outpatient service in our centre from July 2019 to July 2021. Baseline demography and clinical characteristics were collected via electronic medical record system. Data collected was analyzed and compared with historical data from our centre that was collected approximately a decade ago, from April 2006 to May 2009. RESULTS: A total of 354 patients were recruited into this study consisting of 198 male (55.9%) and 156 female (44.1%) with mean age of 63.36 year-old (20–90). The aetiologies of liver cirrhosis were NASH, n = 144, (40.7%); viral hepatitis B, n = 78, (22%); viral hepatitis C, n = 31, (8.8%); alcohol, n= 29, (8.2%); viral hepatitis B + NASH, n = 16, (4.5%); cryptogenic, n = 23, (6.5%) and autoimmune hepatitis, n = 11, (3.1%). NASH was the leading ateology in Malay (50.4%) and Indian (46.3%) while viral Hepatitis B was the main aetiology in Chinese (33.3%). 48 patients (13.6%) had hepatocellular carcinoma with viral hepatitis B being the most dominant cause (45.8%) followed by NASH (18.8%) and alcohol (6.3%). CONCLUSION: Our study showed that there was a drastic change in epidemiology of cirrhosis where the predominant aetiology has changed from viral hepatitis B to NASH. However, viral hepatitis B remained the commonest cause of hepatocellular carcinoma followed by NASH

Changing landscape of liver cirrhosis in multi-racial Asian country: a decade comparison

Objectives: Viral hepatitis B was a commonest cause of cirrhosis in Asian countries, however with the rising prevalence of obesity and prevention strategy for viral hepatitis B, we predict that there is a change in the epidemiology of cirrhosis. Our aim is to determine the change of aetiology of cirrhosis and hepatocellular carcinoma in our centre. Materials and Methods: A cross sectional study was conducted where we recruited all cirrhosis patients who were attending inpatient and outpatient service in our centre from July 2019 to July 2021. Baseline demography and clinical characteristics were collected via electronic medical record system. Data collected was analyzed and compared with historical data from our centre that was collected approximately a decade ago, from April 2006 to May 2009. Results: A total of 354 patients were recruited into this study con- sisting of 198 male (55.9%) and 156 female (44.1%) with mean age of 63.36 year-old (20–90). The aetiologies of cirrhosis were NASH, n = 144, (40.7%); viral hepatitis B, n = 78, (22%); viral hepatitis C, n = 31, (8.8%); alcohol, n = 29, (8.2%); hepatitis B ? NASH, n = 16, (4.5%); cryptogenic, n = 23, (6.5%) and autoimmune hep- atitis, n = 11, (3.1%). NASH was the leading aetiology among Malays (50.4%) compared to Indians (46.3%) and Chinese (32%). Hepatitis B was the main aetiology among Chinese (33.3%) compared to Malays (16%) and Indians (6.3%). Alcohol was the predominant aetiology among Indians (25%) compared to Chinese (4.8%) and Malays (0%). 48 patients (13.6%) had HCC with viral hepatitis B being the dominant cause (45.8%) followed by NASH (18.8%) and alcohol (6.3%). Conclusion: Our study showed that there was a drastic change in epidemiology of cirrhosis where the predominant aetiology have changed from viral hepatitis B to NASH. However, viral hepatitis B remained the commonest cause of HCC followed by NASH