GastroHep

Background. The prognosis of patients with hepatocellular carcinoma (HCC) not eligible to curative treatment is poor. Little information is available on treatment modalities and outcomes of these patients in everyday practice. The aim of this analysis was to describe the characteristics of patients with a newly diagnosed intermediate, advanced, or terminal (IAT) stage of HCC (ICD-10: C220) between 2015 and 2017, either present at diagnosis of HCC or having occurred after disease progression; treatment patterns, HCC aetiologies, and the associated survival were determined using the nationwide claims database. Methods. Patients with HCC were identified using the ICD-10 code C220. IAT stages, defined according to the terminology used in the Barcelona Clinic Liver Cancer classification, were indirectly identified by the presence of at least one of the following treatments: transarterial chemoembolization (TACE), transarterial radioembolization (TARE), HCC systemic therapy, best supportive care (BSC), or an ICD-10 code of metastatic HCC. Treatment patterns were described with an algorithm based on a ranking of palliative treatments identified. Survival was analysed by using Kaplan-Meier curves. Results. 19,649 eligible patients were identified. Their mean age was 70.5 years (SD: 11.0), and 82.5% were males. For 68.8% of patients, the IAT stage was present at HCC diagnosis. On the whole population, 5,114 patients (26.0%) were treated initially with a TACE or TARE, and 4,681 (23.8%) received a targeted systemic therapy at any moment during follow-up with sorafenib in 99.5% of cases. About 7,628 patients (45.6%) received only BSC. Survival since the diagnosis of the AIT stage of HCC differed according to the type of the first received palliative treatment. Median overall survival was 23.8, 9.6, 7.4, and 1.0 months in patients initially receiving TACE, TARE, systemic therapy, and BSC only, respectively. Conclusion. Over the period 2015-2017, hepatocellular carcinoma was still often diagnosed in France at late-stage disease with a very poor prognosis.

Background. Haemochromatosis is a rare autosomal genetic disease that can cause multiple organ failure. In the past, this condition was not considered to affect pregnancy. The objectives of this study are to update the management of haemochromatosis in general as there are new treatments being investigated other than phlebotomy and to summarise the effects of the condition on pregnancy and vice versa. Methods. The initial search was in Ovid Medline® from 2002 to 2013. Review articles for haemochromatosis and case reports of its related complications in pregnancy were found. None of the reviews addressed pregnancy in detail. A second search in PubMed from 2014 to 2016 included studies regarding haemochromatosis and pregnancy and iron metabolism association with other metals and biomarkers, defining the mechanism of foetomaternal risks in maternal haemochromatosis. A third search at PubMed from 2017 to 2022 using key words haemochromatosis and pregnancy was done to look at the new data. Results. The results are qualitative indicating that even in the absence of abnormal iron parameters, haemochromatosis increases the risk of foetomaternal complications due to genetic predisposition, necessitating antenatal monitoring. Newer medications targeting the pathophysiology of the disease to eliminate it are being developed. The coabsorption of lead with iron causes increased risk of maternal preeclampsia, gestational hypertension, foetal congenital abnormalities, and growth problems. There is risk of neurodevelopmental delays, large for gestational age and childhood leukaemia in babies whose mothers and themselves have mutations for haemochromatosis. Conclusion. Previously, women with haemochromatosis were thought to have no higher risk of complications than the general population. However, there is evidence of foetomaternal complications. As a result, pregnancy with haemochromatosis necessitates additional monitoring for both mother and baby.

Background and Aims. Endoscopic variceal ligation (EVL) of esophageal varices alters the portal pressure. We observed the changes in 2D-shear wave elastography (2D-SWE) measurements of spleen and liver following EVL and tried to identify the predictors for rebleeding and mortality at 6 months. Methods. A prospective observational study of 202 patients who underwent EVL for bleeding esophageal varices was done. 2D-SWE measurements of liver stiffness (LS) and spleen stiffness (SS) and spleen volume (SV) were measured half an hour before, 1 hour, 2 weeks, and 6 weeks after EVL. All were followed up for 6 months for rebleeding and all-cause mortality. Results. 83 patients were in child C (41%). Difference in SV, SS, and LS at 2 and 6 weeks from baseline was noted as Delta 2 (2^nd week post-EVL - pre-EVL SV, LS, and SS) and Delta 3 (6^th week post EVL - pre - EVL SV, LS and SS), respectively. Mean Delta 2 VOL and Delta 3 VOL were lower in the bleeding and mortality groups. Delta 2 SS, Delta 3 SS, Delta 2 LS, and Delta 3 LS were higher in the rebleeding and mortality groups. These changes were statistically significant. AUROC in predicting rebleeding was the highest for Delta 2 VOL (0.773) and Delta 3 LS (0.764) amongst the USG parameters that performed better than MELD score (0.677). AUROC in predicting mortality was the highest for Delta 3 VOL and Delta 2 VOL-0.873 and 0.842, respectively, and higher than MELD’s (0.641). Statistically significant variables in binary logistic regression analysis for rebleeding were Delta 3 LS and Delta 3 SS and none for mortality. Conclusion. LS, SS, and SV change after EVL. Changes in liver and spleen stiffness at 6 weeks from baseline had good diagnostic accuracy for predicting rebleeding at 6 months.

Introduction. Upper gastrointestinal (UGI) video capsule endoscopy (VCE) provides a possible alternative to conventional oesophago-gastro-duodenoscopy (OGD). In Ireland, the COVID-19 pandemic led to unprecedented change in endoscopy services, accelerating the need for UGI VCE to help reduce patient exposure but allow the continuation of endoscopy services. We report on using UGI VCE as an alternative to OGD throughout all phases of COVID-related endoscopy adjustments. Aims/Background. Prospective observational study to assess identification of relevant UGI anatomical landmarks on UGI VCE as defined in the British Society of Gastroenterology. Method. Inclusion criteria were: patients with dyspepsia under 40 years of age with no alarm symptoms; known cirrhosis for variceal screening; UGI bleeds with the Blatchford . A protocol for preparation and a series of positional movements were adapted for the procedure. Landmarks and pathology detection were evaluated by two independent endoscopists. Results. 127 UGI VCE was performed from June 2020 to December 2021, of which 22 required further evaluation with OGD. The most common indications were dyspepsia and abdominal pain, 71% and 19%, respectively. With the use of the dual-facing camera, clear views of the OGJ in 100% of cases, cardia 100%, fundus 97%, greater curve 99%, lesser curve 98%, incisura angularis 95%, antrum 95%, pylorus 94%, D1/bulb 83%, and D2 82% were obtained. The main findings at UGI VCE were reflux oesophagitis and gastritis, with normal mucosa observed in 48% of cases. Findings suggesting a neoplastic lesion at the OG junction were detected in 1 case. Conclusion. Since June 2020, 81% () of a selected cohort of patients referred for UGI endoscopy avoided invasive traditional endoscopy and were successfully managed by VCE, thus reducing endoscopy waiting lists. UGI VCE may serve as a clinical diagnostic tool, used alongside OGD in appropriate cases, to help improve patient services and care delivery.

Background. Liver and spleen stiffness measured by shear-wave elastography have been demonstrated to correlate well with liver fibrosis and hepatic venous pressure gradient, respectively. Aim. To investigate the long-term effect of direct-acting antivirals (DAA) on liver and splenic stiffness in patients with chronic hepatitis C. Methods. We conducted a single-centre prospective observational study including 129 chronic hepatitis C patients who achieved a sustained virological response (SVR) with DAA treatment. Liver and spleen stiffness were measured by point shear-wave elastography at pretreatment, end of treatment (EOT), and 48 and 96 weeks after EOT (SVR48 and SVR96, respectively). Results. Liver stiffness measurements (LSM) continued to decline to SVR96, whereas there was no change in spleen stiffness measurements (SSM). Stratified analysis at the SSM 3.2 m/s, which was estimated as the cut-off value of clinically significant portal hypertension, showed that SSM did not change in the low SSM group (SSM <3.2 m/s, n =81), whereas in the high SSM group (SSM ≥3.2 m/s, n =48), the SSM decreased significantly between pretreatment and EOT but did not change thereafter. Moreover, multivariate analysis of risk factors for the SSM remaining in the range of SSM ≥3.2 m/s at SVR96 in the high SSM group revealed that LSM ≥1.93 m/s was a significant factor (p =0.019). Conclusion. These results suggest that DAA treatment of chronic hepatitis C patients may improve liver fibrosis in the long term and some patients with advanced liver fibrosis may not expect an improvement of portal hypertension even if an SVR is achieved.

Herbal medicines including teas and plant extracts have been in use for thousands of years. There are reports of the use of herbal preparations in Egypt, China, India, and Samaria. Many patients consider “natural” herbal teas to be completely free of unwanted side effects. Many herbal products, however, have biological activities that can result in severe hepatic cell toxicity or interact with other herbal products or prescription medications. Their use is increased dramatically. The most common herbal teas and nonmineral natural products are used as self-medication, principally for health improvement. However, these products are potentially dangerous to some individuals. Monitoring for liver injury is an important aspect of drug and herbal safety assessment. When present, herbal-induced liver injury (HILI) may limit the use or result in the discontinuation of these agents. HILI can exhibit with a wide spectrum of clinical and laboratory manifestations, ranging from asymptomatic elevations in aminotransferases to acute liver failure. Most cases of HILI resolve within several weeks after herbal remedy discontinuation. However, some cases can persist as low-level aminotransferase elevations. Our review aims to (1) describe the possible significant discrepancies between the ingredients listed on the label and the actual contents of the preparation; (2) evaluate teas containing multiple plants or herbs which may be adulterated by more toxic herbs, heavy metals, microbials, pharmaceuticals, and medicines; (3) describe pathophysiologic events in herbal tea-induced hepatotoxicity; and (4) discuss the key elements required for attributing the consumption of tea to the induction of liver injury. The widespread use of mixed heterogeneous remedies and the lack of randomized trials are an obstacle to providing safe use of plant-derived teas.