Hepatic venous pressure gradient measurement in pre-primary and primary prophylaxis of variceal hemorrhage

Pharmacological therapy of portal hypertensi¢n can be accomplished according to different objectives. Among them, pre-primary prophylaxis aims to avoid / delay esophageal varices development while the target of primary prophylaxis is protection against first variceal bleeding. Hepatic venous pressure gradient (HVPG) measurement closely reflects portal pressure in most liver diseases whith predominant sinusoidal network involvement. Clinical-hemodynamic correlations have been demonstrated in both pre-primary and primary prophylatic therapy, allowing to establish HVPG measurement as a predictive parameter, not only regarding variceal growth and bled but also of liver disease evolution and other portal hypertensive related complications

Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis

Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients' prognosis, but the initial management of these severe complications continues to present a challenge. The present recommendations aim to increase clinicians' knowledge on the importance of early diagnosis and treatment, and to provide evidence-based management strategies to potentially, further improve patient outcomes. Special attention was given to the role of terlipressin. A comprehensive non-systematic literature search was undertaken to evaluate the evidence for the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis. Recommendations on the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis have been developed based on the best available evidence and the expert opinion of the consensus panel following a comprehensive review of the available clinical data. Prompt identification and timely treatment of acute variceal bleeding and hepatorenal syndrome are essential to reduce the burden.status: publishe

Recommendations on the Diagnosis and Initial Management of Acute Variceal Bleeding and Hepatorenal Syndrome in Patients with Cirrhosis.

Cirrhosis is a serious and life-threatening condition which imposes a significant socioeconomic burden on affected individuals and healthcare systems. Cirrhosis can result in portal hypertension, which may lead to major complications, including acute variceal bleeding and hepatorenal syndrome. Without prompt treatment, these complications may be life-threatening. Over the past 2 decades, new treatment modalities and treatment strategies have been introduced, which have improved patients' prognosis, but the initial management of these severe complications continues to present a challenge. The present recommendations aim to increase clinicians' knowledge on the importance of early diagnosis and treatment, and to provide evidence-based management strategies to potentially, further improve patient outcomes. Special attention was given to the role of terlipressin. A comprehensive non-systematic literature search was undertaken to evaluate the evidence for the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis. Recommendations on the diagnosis and initial management of acute variceal bleeding and hepatorenal syndrome in patients with cirrhosis have been developed based on the best available evidence and the expert opinion of the consensus panel following a comprehensive review of the available clinical data. Prompt identification and timely treatment of acute variceal bleeding and hepatorenal syndrome are essential to reduce the burden

Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide

© 2019 AGA InstituteBackground & Aims: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. Methods: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. Results: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%–37%). The prevalence of MDR bacteria differed significantly among geographic areas, w

Natural history of hepatitis C virus infection in a cohort of asymptomatic post-transfused subjects

Background & aims. Studies about the natural history of hepatitis C virus (HCV) infection report variable progression to cirrhosis depending on study design. Retrospective cross-sectional liver clinic studies overestimate the rate of fibrosis progression due to inclusion of patients with more severe disease leaving mild and asymptomatic patients underrepresented. We evaluated fibrosis progression in a group of “healthy” asymptomatic subjects, attending to a voluntary campaign for the detection of HCV infection.Material and methods. A detection campaign was launched on subjects transfused before 1993. Of 1699 volunteers, 61(3.6%) had HCV infection. A liver biopsy was performed in 40 (65%). Assessed risk factors for liver fibrosis were: sex, body mass index, alcohol consumption (> 20 g/d♀ - >40g/d♂), genotype, HLA-DRB1 alleles, present age, age at infection and duration of infection.Results. 25 (62.5%) were women with a median age of 52.5 years. The median duration of infection was 21.5 years with a median age at infection of 27 years. As regards fibrosis, 25 (62.5%) had a Low Stage (F0-F1), 8 patients, 20%, had severe fibrosis, one patient (2.5%) had cirrhosis. Alcohol consumption was the only risk factor associated with fibrosis progression.Conclusions. The low progression to cirrhosis may be explained by the clinical characteristics of ourpopulation: asymptomatic middle-aged “healthy” subjects infected at young age. The progression to severe fibrosis was noticeable; hence a longer follow-up might demonstrate changes in this outcome. Significant alcohol consumption clearly worsens the natural history of HCV infection; this is no so evident for occasional or mild alcohol consumers

Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay

Introduction and Objectives: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. Materials and Methods: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. Results: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. Conclusions: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032).Fil: Vazquez, Carolina. Hospital Italiano; ArgentinaFil: Gutierrez-Acevedo, María Nelly. Hospital 4 de Junio; ArgentinaFil: Barbero, Sabrina. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Notari, Lorena del Carmen. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Agozino, Marina. Sanatorio Guemes; ArgentinaFil: Fernandez, José Luis. Sanatorio Guemes; ArgentinaFil: Anders, María Margarita. Hospital Alemán; ArgentinaFil: Grigera, Nadia Lorena. Hospital Aleman; ArgentinaFil: Antinucci, Florencia. Hospital Alemán; ArgentinaFil: Orozco Ganem, Orlando Nicolas Federico. Hospital Alemán; ArgentinaFil: Murga, María Dolores. Hospital A. C. Padilla; ArgentinaFil: Perez, María Daniela. Hospital A. C. Padilla; ArgentinaFil: Palazzo, Ana Gracia. Hospital A. C. Padilla; ArgentinaFil: Rejtman, Liria Martinez. Hospital Teodoro J. Schestakow; ArgentinaFil: Duarte, Ivonne Giselle. Hospital 4 de Junio; ArgentinaFil: Vorobioff, Julio Daniel. Hospital Provincial del Centenario; ArgentinaFil: Trevizan, Victoria. Hospital Provincial del Centenario; ArgentinaFil: Bulaty, Sofía. Hospital Provincial del Centenario; ArgentinaFil: Bessone, Fernando. Hospital Provincial del Centenario; ArgentinaFil: Valverde, Marcelo. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Elizondo, Martín. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Borzi, Silvia Mabel. Hospital Prof. Rodolfo Rossi; ArgentinaFil: Stieben, Teodoro Eduardo. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Masola, Adriano Carlos. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Tomatis, Jesica. Hospital Privado de Rosario; ArgentinaFil: Pages, Josefina. Universidad Austral; ArgentinaFil: Tevez, Silvina. Sanatorio Guemes; ArgentinaFil: Gadano, Adrián Carlos. Hospital Italiano; ArgentinaFil: Giunta, Diego Hernan. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Marciano, Sebastián. Hospital Italiano; Argentin

Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries.

Nitrofurantoin is a synthetic antibiotic that is recommended as first-choice treatment for uncomplicated urinary tract infections. The prescription of this drug has increased dramatically, especially in Latin American countries. We described the demographics, clinical characteristics, biochemical features, and outcome of nitrofurantoin-induced liver injury. We analyzed 23 cases from the Latin American DILI Network (LATINDILI) and the Spanish DILI Registry. Causality was assessed with the RUCAM and RECAM scale. Of the 23 DILI cases included in our series, 96% patients were women, and the mean age of the whole cohort was 61 years. The median time of drug exposure was 175 days (interquartile range [IQR] 96-760), with 11 patients who were prescribed nitrofurantoin for more than six months. Hepatocellular damage was the most frequent pattern of liver injury (83%), and nearly half of the patients had an asymptomatic presentation (52%). Neither death nor liver transplantation was documented in this series. Overall, 65% of the patients (n = 15) presented with positive autoantibody titres. The median time to resolution was 81 days (IQR 57-141), and 15 patients (83%) recovered within six months. Five patients (22%) developed nitrofurantoin-induced autoimmune-like hepatitis (NI-AILH), of whom two were characterized by a persistent increase in transaminases that required immunosuppressive treatment to achieve normalization of liver enzymes. Clinicians who prescribe nitrofurantoin should be aware that patients who had taken nitrofurantoin for a long term may be at risk of developing nitrofurantoin-induced autoimmune-like hepatitis

Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries

Nitrofurantoin is a synthetic antibiotic that is recommended as first-choice treatment for uncomplicated urinary tract infections. The prescription of this drug has increased dramatically, especially in Latin American countries. We described the demographics, clinical characteristics, biochemical features, and outcome of nitrofurantoin-induced liver injury. We analyzed 23 cases from the Latin American DILI Network (LATINDILI) and the Spanish DILI Registry. Causality was assessed with the RUCAM and RECAM scale. Of the 23 DILI cases included in our series, 96% patients were women, and the mean age of the whole cohort was 61 years. The median time of drug exposure was 175 days (interquartile range [IQR] 96–760), with 11 patients who were prescribed nitrofurantoin for more than six months. Hepatocellular damage was the most frequent pattern of liver injury (83%), and nearly half of the patients had an asymptomatic presentation (52%). Neither death nor liver transplantation was documented in this series. Overall, 65% of the patients (n = 15) presented with positive autoantibody titres. The median time to resolution was 81 days (IQR 57–141), and 15 patients (83%) recovered within six months. Five patients (22%) developed nitrofurantoin-induced autoimmune-like hepatitis (NI-AILH), of whom two were characterized by a persistent increase in transaminases that required immunosuppressive treatment to achieve normalization of liver enzymes. Clinicians who prescribe nitrofurantoin should be aware that patients who had taken nitrofurantoin for a long term may be at risk of developing nitrofurantoin-induced autoimmune-like hepatitis.Fil: Bessone, Fernando. Hospital Provincial del Centenario; ArgentinaFil: Ferrari, Antonella. Hospital Provincial del Centenario; ArgentinaFil: Hernandez, Nelia. Hospital de Clinicas Dr. Manuel Quintela; UruguayFil: Mendizabal, Manuel. Universidad Austral; ArgentinaFil: Ridruejo, Ezequiel. Centro de Educación Medica E Invest.clinicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Zerega, Alina. Hospital Allende; ArgentinaFil: Tanno, Federico Carlos. Hospital Provincial del Centenario; ArgentinaFil: Reggiardo, María Virginia. Hospital Provincial del Centenario; ArgentinaFil: Vorobioff, Julio. Hospital Provincial del Centenario; ArgentinaFil: Tanno, Hugo Enrique. Hospital Provincial del Centenario; ArgentinaFil: Arrese, Marco. Pontificia Universidad Católica de Chile; Chile. Universidad Católica de Chile; ChileFil: Nunes, Vinicius. Universidade Federal da Bahia; BrasilFil: Tagle, Martin. Clínica Anglo Americana; PerúFil: Medina Caliz, Inmaculada. Universidad de Málaga; EspañaFil: Robles Diaz, Mercedes. Universidad de Málaga; EspañaFil: Niu, Hao. Universidad de Málaga; EspañaFil: Alvarez Alvarez, Ismael. Universidad de Málaga; EspañaFil: Stephens, Camilla. Universidad de Málaga; EspañaFil: Lucena, M. Isabel. Universidad de Málaga; EspañaFil: Andrade, Raul J.. Universidad de Málaga; Españ