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Les derniers abstracts de la revue European Journal of Gastroenterology & Hepatology - Current Issue :

    Date de mise en ligne : Jeudi 01 janvier 1970
    Li, Xiaoyan; Jiang, Tingting; Gao, Jian
    Endoscopic variceal ligation combined with argon plasma coagulation versus ligation alone for the secondary prophylaxis of variceal bleeding: a systematic review and meta-analysis
    imageEndoscopic variceal ligation (EVL) is often recommended as an effective method for the treatment of esophageal varices, despite the important tendency of variceal recurrence. Recent studies indicate that combining EVL with argon plasma coagulation (APC) may be a more effective therapy than ligation alone. To investigate these findings, we carried out a systematic review and meta-analysis to compare the safety and efficacy of EVL combined with APC versus ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage. All studies were searched through PubMed, the Cochrane Library, and Science Direct. The outcome measures were relative risk (RR) or risk difference with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference for continuous data. Heterogeneity was calculated using the χ2 and the I2-tests. Two investigators independently identified four randomized-controlled trials included in the research. The variceal recurrence rate was significantly lower in the combined therapy group (RR=0.19, 95% CI: 0.09–0.41, P=0.000). The bleeding recurrence and mortalities in the two groups showed no significant differences (RR=0.29, 95% CI: 0.08–1.04, P=0.058; risk difference=−0.02, 95% CI: –0.08–0.04, P=0.576, respectively). Although the pyrexia incidence rate was significantly higher in the combined group (RR=3.42, 95% CI: 1.56–7.48, P=0.002), there was intertrial heterogeneity (I2=52.5%, P=0.097). EVL combined with APC is superior to ligation alone for endoscopic variceal recurrence without severe adverse events in secondary prophylaxis against esophageal variceal bleeding. More high-quality studies are needed to strengthen this conclusion.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Roncero, Carlos; Littlewood, Richard; Vega, Pablo; Martinez-Raga, Jose; Torrens, Marta
    Chronic hepatitis C and individuals with a history of injecting drugs in Spain: population assessment, challenges for successful treatment
    imageIn Spain, there is a need to improve chronic hepatitis C care among people who inject drugs (PWID). Injecting drug use is an important risk behaviour for hepatitis C virus (HCV) infection. Review of 28 sources of the relevant published literature mapped the size of the addiction-HCV population in Spain. Experts in opioid use disorder (OUD) treatment in Spain completed a consensus to define the population size, HCV prevalence and access or barriers to hepatitis C treatment for PWID populations. In Spain, over 300 000 individuals have a lifetime history of injecting drugs. Currently, 150 000 individuals in Spain have OUD; many have injected drugs. Each year, 80 000 individuals engage with treatment services for OUD. A proportion of this group continues to inject drugs. There is a high HCV prevalence in PWID – estimates of 60–80% in Spain. Uptake of hepatitis C therapy in PWID in Spain is limited; barriers include awareness of treatment pathways, advocacy for regular screening and effective joint care. There is an urgent need to address barriers to effective hepatitis C care for PWID in Spain. Practical and specific strategies including peer-led solutions, patient buddy systems and joint working models at the local level can make important short-term differences.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Royston, Christine; Bardhan, Karna D.
    Adam, Eve and the reflux enigma: age and sex differences across the gastro-oesophageal reflux spectrum
    imageIntroduction: We present demographic differences across the gastro-oesophageal reflux disease (GORD) spectrum in a UK District General Hospital. Patients and methods: Data were prospectively collected over 37 years. At endoscopy patients were categorized as: erosive oesophagitis (EO), Barrett’s oesophagus (BO) or nonerosive reflux disease (NER). Analysis 1: comparison of EO, BO and NER 1977–2001 when the database for GORD without BO closed. Analysis 2: demographic differences in oesophageal adenocarcinoma (OAC) in total BO population diagnosed 1977–2011. Results: GORD 1977–2001 (n=11 944): sex, male predominance in EO and BO but not NER; male : female ratios, 1.81, 1.65, 0.87, respectively (P<0.0001); mean age at presentation, EO 54 years, BO 62 years, NER 50 years; women were older than men by 10, 7 and 6 years, respectively. BO 1977–2011: prevalent OAC, 87/1468 (6%); male : female ratio, 4.1 (P<0.0001); incident OAC, 54/1381 (3.9%); male : female ratio, 3.5 (P<0.0001). Among all BO, more men developed OAC (3 vs. 0.9%). Within each sex, proportion of OAC higher among men (4.9 vs. 2.3%); at OAC diagnosis women were slightly but not significantly older (69.9 vs. 72.3 years, P=0.322). Conclusion: Two views may explain our findings. First, women have either milder reflux, or reduced mucosal sensitivity hence reflux remains silent for longer. Alternatively, women genuinely develop reflux later, that is, are more protected and for longer from developing GORD and its complications. Early evidence is emerging that female sex hormones may indeed have a protective role in GORD during the reproductive period. We suggest reflux and its consequences may be an example of ‘protection’ conferred on Eve.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Holmes, Geoffrey K.T.; Forsyth, Julia M.; Knowles, Sarah; Seddon, Helen; Hill, Peter G.; Austin, Andrew S.
    Coeliac disease: further evidence that biopsy is not always necessary for diagnosis
    imageObjectives: Growing evidence supports the view that the diagnosis of coeliac disease (CD) can be made by serological tests alone, although this approach is still not widely accepted. We previously showed in retrospective and prospective studies that in adults an IgA-tissue transglutaminase antibody cut-off can be defined above which the positive predictive value for CD is 100%. Following a change in the analytical method for measuring the antibody, our objectives were to re-examine this finding in a larger series of adults to ascertain whether a diagnosis of CD can be reliably made in a proportion of patients without the need for small bowel biopsy and to re-evaluate the diagnostic guidelines used in our centre. Patients and methods: A retrospective analysis was done in an unselected series of 270 adult patients who had small bowel biopsies and serum IgA-tissue transglutaminase antibody levels measured from 2009 to 2014. Results: At an IgA-tissue transglutaminase antibody cut-off greater than 45 U/ml (>8×upper limit of normal+2SDs) the positive predictive value for CD in this cohort was 100%; 40% of cases were above this cut-off. Conclusion: We have verified that a diagnosis of CD can be reliably made in a high proportion of adults based on serology alone using the IgA-tissue transglutaminase antibody method specified. These results add to the body of evidence that small bowel biopsy should no longer be considered mandatory for the diagnosis of CD. On the basis of these results the diagnostic guidelines in our centre have been modified.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Coenen, Sofie; Weyts, Ellen; Vermeire, Séverine; Ferrante, Marc; Noman, Maja; Ballet, Vera; Vanhaecht, Kris; Van Assche, Gert
    Effects of introduction of an inflammatory bowel disease nurse position on the quality of delivered care
    imageBackground and aims: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice, and support. We investigated the effect of the introduction of an IBD nurse on the quality of care delivered. Methods: In September 2014, an IBD nurse position was instituted in our tertiary referral center. All contacts and outcomes were prospectively recorded over a 12-month period using a logbook kept by the nurse. Results: Between September 2014 and August 2015, 1313 patient contacts were recorded (42% men, median age: 38 years, 72% Crohn’s disease, 83% on immunosuppressive therapy). The contacts increased with time: Q1 (September–November 2014): 144, Q2: 322, Q3: 477, and Q4: 370. Most of the contacts were assigned to scheduling of follow-up (316/1420), start of new therapy (173/1420), therapy follow-up (313/1420), and providing disease information (227/1420). In addition, 134 patients contacted the IBD nurse for flare management and a smaller number for administrative support, psychosocial support, and questions about side effects. During the study period, 30 emergency room and 133 unscheduled outpatient visits could be avoided through the intervention of the IBD nurse. A faster access to procedures and other departments could be provided for 136 patients. Conclusion: The role of IBD nurses as the first point of contact and counseling is evident from a high volume of nurse–patient interactions. Avoidance of emergency room and unscheduled clinic visits are associated with these contacts.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Mujagic, Zlatan; Jonkers, Daisy M.A.E.; Hungin, A. Pali S.; de Wit, Niek J.; Wensaas, Knut-Arne; Palka, Margaret; Leeters, Vico; Kruimel, Joanna W.; Leue, Carsten; Masclee, Ad A.M.; Muris, Jean W.M.
    Use of Rome criteria for the diagnosis of irritable bowel syndrome in primary care: a survey among European countries
    imageBackground and objectives: The majority of patients with irritable bowel syndrome (IBS) are diagnosed and treated in primary care. The aim of this study was to investigate the implementation of the Rome criteria in daily primary care clinical practice and adherence of general practitioners (GPs) to recommended diagnostic approaches for IBS. Patients and methods: A survey consisting of 18 questions was distributed across 11 European countries and was used to assess GPs’ diagnostic approach of IBS, the use of Rome criteria in daily practice and GPs’ perspective on the aetiology of the disorder. Results: Overall, 185 GPs completed the survey. In daily clinical practice, 32% of GPs reported that they usually make a positive diagnosis on the basis of symptoms only, whereas 36% of GPs reported regular use of the Rome criteria to diagnose IBS. Furthermore, 62% of the responders reported that they applied additional diagnostics, such as blood tests, 31% found it necessary to perform endoscopy to make a positive diagnosis of IBS and 29% referred patients with IBS to a specialist. Psychological factors were the most frequently selected potential aetiological factor of IBS (88% of GPs). Overall, 52% of GPs reported systematically including questions on psychological symptoms in the assessment of history of IBS. Conclusion: Only about one-third of GPs regularly used the Rome criteria to diagnose IBS. In daily primary care practice, IBS largely remains a diagnosis of exclusion. This has implications in terms of GPs’ specialty training and questions the applicability of IBS guidelines in daily care, which advocate an early, positive, symptom-based diagnosis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Silva, Mário J.; Pereira, Cláudia; Loureiro, Rafaela; Balsa, Catarina; Lopes, Paulo; Água-Doce, Ivone; Belo, Elsa; Martins, Helena C.; Coutinho, Rodrigo; Pádua, Elizabeth
    Hepatitis C in a Mobile Low-Threshold Methadone Program
    imageIntroduction: Data on the epidemiology of hepatitis C among individuals who use drugs in low-threshold settings are lacking, although crucial to assess the burden of disease and aid in the design of treatment strategies. Objective: The aim of this study was to characterize the epidemiology and disease related to hepatitis C in a population attending a low-threshold methadone program. Materials and methods: A cross-sectional study in the population attending the Mobile Low-Threshold Methadone Program in Lisbon, Portugal, was carried out. The survey included assessment of risk factors for infection with hepatitis C virus (HCV) and liver disease, HCV serology and RNA detection, HCV genotyping, and liver disease staging. Results: A total of 825 participants were enrolled, 81.3% men, mean age 44.5 years. Injecting drug use (IDU) was reported by 58.4% – among these, 28.2% were people who inject drugs. Excessive drinking and HIV coinfection were reported by 33.4 and 15.9%, respectively. Among participants with active infection, 16.9% were followed up in hospital consultation. The overall seroprevalence for HCV was 67.6% (94.2% in IDU, 30.0% in non-IDU, 97.1% in people who inject drugs, and 75.6% in excessive drinkers). Among seropositives for HCV, active infection was present in 68.4%. Among individuals with active infection, the most common genotypes were 1a (45.3%) and 3a (28.7%), whereas 30% had severe liver fibrosis or cirrhosis. Age 45 years or older, HCV genotype 3, and coinfection with HIV were significant predictors of cirrhosis. Conclusion: This population has a high burden of hepatitis C and several characteristics that favor dissemination of infection. Healthcare strategies are urgently needed to address hepatitis C in this setting.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Ozturker, Coskun; Karagoz, Ergenekon; Sivrioglu, Ali K.; Kara, Kemal
    Clinical usefulness and performance of acoustic radiation force impulse in patients with chronic hepatitis B
    imageAim: The aim of this study was to evaluate the performance of acoustic radiation force impulse (ARFI) compared with liver biopsy in quantifying fibrosis levels in patients with chronic hepatitis B (CHB). Patients and methods: The study was approved by the institutional review board at our hospital. One hundred CHB patients and 30 healthy controls (130 individuals) were included in the study. ARFI measurements were performed on all of these cases. CHB was diagnosed when serum hepatitis surface antigen was positive for more than 6 months and when persistent or intermittent elevations in alanine aminotransferase and aspartate aminotransferase levels and histopathological changes in liver biopsy were present. Liver biopsies were taken as a reference standard for 100 CHB patients. Liver biopsy samples were examined using the Ishak scoring system and compared with ARFI velocity values. Results: Of the 130 participants, 107 (82.3%) were men and 23 (17.7%) were women. Thirty of these participants were healthy controls and their fibrotic score was evaluated as an Ishak fibrosis score of 0. A gradual increase in the mean velocity value was obtained for fibrosis scores F0–F6 (Ishak fibrosis score) in our study. A strong positive correlation was found between the mean velocity values and fibrosis scores of liver biopsy that were performed on liver segment 8. The area under the receiver operating characteristic curve was used to detect the best cutoff velocity values, and no or mild fibrosis (F≤2), significant fibrosis (F≥3), and severe fibrosis (F≥5) were calculated to be 0.95, 1.75, and 2.55 m/s, respectively. When a cutoff value of 1.75 m/s was used, ARFI had a sensitivity of 83% and a specificity of 98% in differentiating patients with fibrosis score F≤2 versus F≥3. Conclusion: ARFI elastography in patients with CHB can be considered an easy-to-use and accurate noninvasive tool to evaluate the severity of liver fibrosis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Gao, Fangyuan; Sun, Le; Ye, Xieqiong; Liu, Yao; Liu, Huimin; Geng, Mingfan; Li, Xiaoshu; Yang, Xue; Li, Yuxin; Wang, Rui; Chen, Jialiang; Wan, Gang; Jiang, Yuyong; Wang, Xianbo
    Development and validation of a prognostic model for acute-on-chronic hepatitis B liver failure
    imageAim: The CANONIC study proposed the Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF) prognostic model at the European Association for the Study of the Liver-CLIF diagnosis. This study aimed to develop and validate a prognostic model for predicting the short-term mortality of hepatitis B virus (HBV) ACLF as defined by the Asia-Pacific Association for the Study of the Liver. Patients and methods: A retrospective cohort of 381 HBV ACLF patients and a prospective cohort of 192 patients were included in this study. Independent predictors of disease progression were determined using univariate and multivariate Cox proportional hazard regression analysis, and a regression model for predicting prognosis was established. Patient survival was estimated by Kaplan–Meier analysis and subsequently compared by log-rank tests. The area under the receiver operating characteristic curve was used to compare the performance of various current prognostic models. Results: Our model was constructed with five independent risk factors: hepatic encephalopathy, international normalized ratio, neutrophil–lymphocyte ratio, age, and total bilirubin, termed as the HINAT ACLF model, which showed the strongest predictive values compared with CLIF-C ACLF, CLIF-C Organ Failure, Sequential Organ Failure Assessment, CLIF-Sequential Organ Failure Assessment, Model for End-stage Liver Disease, Model for End-stage Liver Disease-sodium, and Child–Turcotte–Pugh scores; this model reduced the corresponding prediction error rates at 28 and 90 days by 16.4–54.5% after ACLF diagnosis in both the derivation cohort and the validation cohorts. Conclusion: The HINAT ACLF model can accurately predict the short-term mortality of patients with HBV ACLF as defined by Asia-Pacific Association for the Study of the Liver.

    Date de mise en ligne : Jeudi 01 janvier 1970
    North, Carol S.; Pollio, David E.; Sims, Omar T.; Jain, Mamta K.; Brown, Geri R.; Downs, Dana L.; Lisker-Melman, Mauricio; Hong, Barry A.
    An effectiveness study of group psychoeducation for hepatitis C patients in community clinics
    imageObjective: A successful psychoeducation program for serious mental illness, PsychoEducation Responsive to Families (PERF), was modified for hepatitis C virus (HCV). An effectiveness study was carried out comparing HCV-PERF with didactic education. Patients and methods: A sample of 309 adult HCV patients was recruited from three outpatient settings and randomized (60% HCV-PERF, 40% didactic control). Groups met for 90 min bimonthly for 6 months following separate structured protocols. HCV-PERF sessions included a didactic curriculum developed uniquely for groups by member choice, with group problem-solving and support interactions. Patients were assessed at baseline, after the intervention, and 1 year later. Demographic and HCV-related variables and structured diagnostic interview data were obtained. Results: Both groups improved significantly on major depression and alcohol and drug use, quality of life, risk behaviors, and treatment satisfaction, and worsened on disability and perceived HCV-related problems. Intervention groups did not differ on outcomes. Conclusion: Even though the active intervention did not achieve a significant improvement relative to the control condition, the observable improvements in both conditions warrant further exploration of the contributions of education and support as potentially important elements of HCV behavioral intervention. Further study is needed to identify elements common to education interventions that may be contributory to the improved outcomes over time.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Su, Feng; Beste, Lauren A.; Green, Pamela K.; Berry, Kristin; Ioannou, George N.
    Direct-acting antivirals are effective for chronic hepatitis C treatment in elderly patients: a real-world study of 17 487 patients
    imageBackground: The mean age of patients with chronic hepatitis C virus (HCV) infection in the USA has been increasing. Despite the increasing proportion of HCV-infected elderly patients, this group is under-represented in clinical trials of HCV treatment. Aim: We aimed to describe the real-world effectiveness of direct-acting antivirals (DAAs) among elderly patients. Patients and methods: We retrospectively identified 17 487 HCV-infected patients who were started on treatment with sofosbuvir, ledipasvir/sofosbuvir, or paritaprevir/ombitasvir/ritonavir/dasabuvir-based regimens in the Veterans Affairs Healthcare System between 1 January 2014 and 30 June 2015. We ascertained sustained virologic response (SVR) rates in patients aged below 55, 55–59, 60–64, 65–69, 70–74, and 75 years or older and performed multivariable logistic regression to determine whether age predicted SVR. Results: Overall unadjusted SVR rates were 91.2% [95% confidence interval (CI): 89.7–92.4], 89.8% (95% CI: 88.8–90.7), 90.8% (95% CI: 90.1–91.6), 91.1% (95% CI: 90.1–91.9), 90.0% (95% CI: 86.9–92.4), and 93.8% (95% CI: 88.8–96.7) in patients aged below 55, 55–59, 60–64, 65–69, 70–74, and 75 years or older. Unadjusted SVR rates were similar in all age groups after stratifying by genotype, treatment regimen, stage of liver disease, and treatment experience. In multivariate models, age was not predictive of SVR after adjusting for confounders. Conclusion: DAAs produce high rates of SVR in all age groups, including patients in our oldest age category (≥75 years). Advanced age in and of itself should not be considered a barrier to initiating DAA treatment.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Jaruvongvanich, Veeravich; Ahuja, Wasin; Wijarnpreecha, Karn; Ungprasert, Patompong
    Hyperuricemia is not associated with severity of liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis
    imageBackground: Uric acid is a natural antioxidant. Previous studies have suggested a protective role of hyperuricemia against liver fibrosis among patients with nonalcoholic fatty liver disease (NAFLD). However, the results were conflicting. Methods: MEDLINE and EMBASE databases were searched through August 2016 for studies that investigated the association between hyperuricemia and fibrosis stage among patients with biopsy-proven NAFLD. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model, generic inverse variance method of DerSimonian and Laird. The between-study heterogeneity of effect size was quantified using the Q statistic and I2. Results: A total of five observational studies with 749 NAFLD patients were identified. Patients with NAFLD who had hyperuricemia were not significantly more likely or less likely to have advanced liver fibrosis (defined as fibrosis stage of ≥3) compared with patients with NAFLD who had normal serum uric with the pooled odds ratio of 0.72 (95% confidence interval: 0.34–1.53). The statistical heterogeneity was low with an I2 of 22% (Pheterogeneity=0.27). Conclusion: Significant protective role of hyperuricemia against the development of advanced liver fibrosis in patients with NAFLD was not observed in this meta-analysis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Zhou, Xiao-Dong; Zhang, Jia-Ying; Liu, Wen-Yue; Wu, Sheng-Jie; Shi, Ke-Qing; Braddock, Martin; Chen, Yong-Ping; Huang, Wei-Jian; Zheng, Ming-Hua
    Quick chronic liver failure-sequential organ failure assessment: an easy-to-use scoring model for predicting mortality risk in critically ill cirrhosis patients
    imageBackground and aim: Critically ill cirrhosis patients have an increased risk of morbidity and mortality, even after admission to the ICU. Our objectives were to compare the predictive accuracy of model for end-stage liver disease (MELD), MELD-Na, UK model for end-stage liver disease, and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) by the development and validation of an easy-to-use prognostic model [named quick CLIF-SOFA (qCLIF-SOFA)] for early risk prediction in critically ill patients with cirrhosis. Patients and methods: Overall, 1460 patients were extracted from the MIMIC-III database and enrolled in this study at 30-day and 90-day follow-up. qCLIF-SOFA was developed in the established cohort (n=730) and a performance analysis was completed in the validation cohort (n=730) using area under the receiver operating characteristic curve. Results were compared with CLIF-SOFA. Results: The performance of CLIF-SOFA was significantly better than that of MELD, MELD-Na, and UK model for end-stage liver disease for predicting both 30-day and 90-day mortality (all P<0.05). qCLIF-SOFA consisted of five independent factors (bilirubin, creatinine, international normalized ratio, mean arterial pressure, and vasopressin) associated with mortality. In the established cohort, CLIF-SOFA and qCLIF-SOFA predicted mortality with area under the receiver operating characteristic curve values of 0.768 versus 0.743 at 30-day, 0.747 versus 0.744 at 90-day, and 0.699 versus 0.706 at 1 year, respectively (all P>0.05). A similar result was observed in the validation cohort (0.735 vs. 0.734 at 30 days, 0.723 vs. 0.737 at 90 days, and 0.682 vs. 0.700 at 1 year, respectively, all P>0.05). Conclusion: The utility of CLIF-SOFA was further shown to predict mortality for critically ill cirrhosis patients. The novel and simpler qCLIF-SOFA model showed comparable accuracy compared with existing CLIF-SOFA for prognostic prediction.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Adhoute, Xavier; Pénaranda, Guillaume; Raoul, Jean Luc; Bollon, Emilie; Pol, Bernard; Letreut, Yves P.; Perrier, Hervé; Bayle, Olivier; Monnet, Olivier; Beaurain, Patrick; Muller, Cyril; Hardwigsen, Jean; Lefolgoc, Gaëlle; Castellani, Paul; Bronowicki, Jean P.; Bourlière, Marc
    NIACE score for hepatocellular carcinoma patients treated by surgery or transarterial chemoembolization
    imageBackground and aims: Hepatocellular carcinoma (HCC) prognostic scores could be useful in addition to the Barcelona Clinic Liver Cancer (BCLC) system to clarify patient prognosis and guide treatment decision. The NIACE (tumor Nodularity, Infiltrative nature of the tumor, serum Alpha-fetoprotein level, Child–Pugh stage, ECOG performance status) score distinguishes different prognosis groups among BCLC A, B, and C HCC patients. Our aims are to evaluate the NIACE score and its additive value in two HCC cohorts treated either by surgery or by chemoembolization, and then according to the BCLC recommendations. Patients and methods: This was a retrospective multicenter study with two BCLC A, B, and C HCC cohorts treated either by surgery (n=207) or by chemoembolization (n=168) carried out between 2008 and 2013. We studied survival time according to the baseline NIACE score and compared it with the Cancer of the Liver Italian Program score and the BCLC system. Results: The NIACE score differentiates between subgroups of patients with different prognosis within each BCLC class. Among BCLC A patients treated by surgery and BCLC B patients treated by chemoembolization, the NIACE score differentiates between two subgroups with a significant difference in survival time: 68 (55–81) months versus 35 (21–56) months (P=0.0004) and 20 (17–24) months versus 13 (7–17) months (P=0.0008), respectively. Among those subgroups, the NIACE score has a significantly better prognostic value than the BCLC system or the Cancer of the Liver Italian Program score. Conclusion: In this study, among HCC patients treated according to the BCLC recommendations, the NIACE score predicts more accurately than any other system the survival time.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Benko, Tamas; Gallinat, Anja; Minor, Thomas; Saner, Fuat H.; Sotiropoulos, Georgios C.; Paul, Andreas; Hoyer, Dieter P.
    The postoperative Model for End stage Liver Disease score as a predictor of short-term outcome after transplantation of extended criteria donor livers
    imageBackground: Recently, the postoperative Model for End stage Liver Disease score (POPMELD) was suggested as a definition of postoperative graft dysfunction and a predictor of outcome after liver transplantation (LT). Aim: The aim of the present study was to validate this concept in the context of extended criteria donor (ECD) organs. Patients and methods: Single-center prospectively collected data (OPAL study/01/11-12/13) of 116 ECD LTs were utilized. For each recipient, the Model for End stage Liver Disease (MELD) score was calculated for 7 postoperative days (PODs). The ability of international normalized ratio, bilirubin, aspartate aminotransferase, Donor Risk Index, a recent definition of early allograft dysfunction, and the POPMELD was compared to predict 90-day graft loss. Predictive abilities were compared by receiver operating characteristic curves, sensitivity and specificity, and positive and negative predictive values. Results: The median Donor Risk Index was 1.8. In all, 60.3% of recipients were men [median age of 54 (23–68) years]. The median POD1–7 peak-aspartate aminotransferase value was 1052 (194–17 577) U/l. The rate of early allograft dysfunction was 22.4%. The 90-day graft survival was 89.7%. Out of possible predictors of the 90-day graft loss MELD on POD5 was the best predictor of outcome (area under the curve=0.84). A MELD score of 16 or more on POD5 predicted the 90-day graft loss with a specificity of 80.8%, a sensitivity of 81.8%, and a positive and negative predictive value of 31 and 97.7%. Conclusion: A MELD score of 16 or more on POD5 is an excellent predictor of outcome in ECD donor LT. Routine evaluation of POPMELD scores might support clinical decision-making and should be reported routinely in clinical trials.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Schellhaas, Barbara; Strobel, Deike; Wildner, Dane; Goertz, Ruediger S.; Neurath, Markus F.; Pfeifer, Lukas
    Two-dimensional shear-wave elastography: a new method comparable to acoustic radiation force impulse imaging?
    imageObjectives: Two-dimensional shear-wave elastography (2D-SWE) is an ultrasound-based technique for the noninvasive assessment of tissue stiffness. In contrast to the well-established point-shear-wave elastography (pSWE) method acoustic radiation force impulse imaging, there is little evidence on the performance and usefulness of 2D-SWE in the assessment of liver stiffness. Thus, the aim of our study was to compare 2D-SWE versus pSWE. Materials and methods: 2D-SWE and pSWE were performed in 20 cirrhotic patients, 20 healthy individuals and an elasticity phantom. Stiffness values, examination time and number of measurements were compared. For 2D-SWE, the influence of size of the region of interest (ROI) was assessed. Results: Elastography values in healthy individuals were slightly higher for 2D-SWE versus pSWE (1.4 m/s, range: 1.21–1.68 vs. 1.23 m/s, range: 1.07–1.39). In cirrhotic patients, there were no significant differences (3.06 m/s, range: 1.83–5.35 vs. 3 m/s, range: 1.67–4.37 m/s). Examination times were significantly longer for 2D-SWE in both patient groups (mean values for healthy/cirrhotic patients: 129.6/157.1 vs. 75/71.6 s). For 2D-SWE, variation of ROI size (5, 10, 20 mm) produced comparable results. After eight measurements, 90% of cirrhotic patients showed less than 5% of deviation from the results after the gold standard of 10 measurements; for healthy individuals, this was observed after six measurements. Conclusion: 2D-SWE seems to be comparable to pSWE (acoustic radiation force impulse-imaging) in cirrhotic patients, with slightly higher values in healthy individuals. 2D-SWE measurements require considerably more time. For 2D-SWE, ROI size seems to be of minor importance; multiple measurements should be obtained as single measurements differ. These preliminary results should be confirmed in larger patient collectives with histology as the reference standard.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Veiga, Zulane S.T.; Villela-Nogueira, Cristiane A.; Fernandes, Flávia F.; Cavalcanti, Marta G.; Figueiredo, Fátima A.; Pereira, João L.; Pereira, Gustavo H.; Moraes Coelho, Henrique S.; Peralta, José M.; Marques, Carlos E.; Perez, Renata M.; Fogaça, Homero S.
    Transient elastography evaluation of hepatic and spleen stiffness in patients with hepatosplenic schistosomiasis
    imageBackground: Hepatosplenic schistosomiasis (HES) has not been evaluated by transient elastography so far and its correlation with ultrasound variables remains to be defined. Aims: The aim of this study was to describe the parameters of liver and spleen stiffness in HES assessed by transient elastography in comparison with cirrhotics and controls evaluating its correlation with ultrasonographic data. Patients and methods: HES, hepatitis C virus-cirrhotic, and control patients were included in this sectional study. Liver and spleen stiffness were compared among the three groups. The ultrasonographic parameters were compared with transient elastography in HES patients. Results: Thirty HES, 30 hepatitis C virus-cirrhotic patients, and 17 controls were included. Those with HES presented liver stiffness that was significantly higher than the controls and lower than the cirrhotics: 9.7 (3.6–75.0) versus 3.7 (2.8–5.4) versus 27.0 (14.7–61.5) kPa (P<0.001). Spleen stiffness values were comparable between hepatosplenic and cirrhotics: 66.4 (25.7–75.0) versus 69.1 (18.0–75.0) kPa (P=0.78) and were significantly higher than the controls 16.5 kPa (6.3–34.3) (P<0.001). In patients with HES, high spleen stiffness was associated with right liver lobe diameter (P=0.015), splenic artery resistance index (P=0.002), portal vein diameter (P=0.021), portal vein area (P=0.008), portal vein congestion index (P=0.035), splenic vein diameter (P=0.013), and spleen diameter (P=0.021). Conclusion: Liver stiffness may be a useful tool to differentiate portal hypertension related to cirrhosis from that of HES. High spleen stiffness is a potential surrogate marker of portal hypertension in this population.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Cardile, Sabrina; Candusso, Manila; Papadatou, Bronislava; Bracci, Fiammetta; Knafelz, Daniela; Torre, Giuliano
    Lack of efficacy of infliximab in the treatment of primary sclerosing cholangitis in inflammatory bowel diseases in childhood
    imageNo abstract available

    Date de mise en ligne : Jeudi 01 janvier 1970
    Jia, Zhongzhi; Jiang, Guomin
    Regarding the ‘Role of low-molecular-weight heparins in prevention of thromboembolic complication after transarterial chemoembolization in hepatocellular carcinoma’
    No abstract available

    Date de mise en ligne : Jeudi 01 janvier 1970
    Paper alert
    No abstract available