Hepatobiliary manifestations are common in inflammatory bowel disease(IBD),with 30%of patients presenting abnormal liver tests and 5%developing chronic liver disease.They range from asymptomatic elevated liver tests t...Hepatobiliary manifestations are common in inflammatory bowel disease(IBD),with 30%of patients presenting abnormal liver tests and 5%developing chronic liver disease.They range from asymptomatic elevated liver tests to lifethreatening disease and usually follow an independent course from IBD.The pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background(in primary sclerosing cholangitis,IgG4-related cholangitis,and autoimmune hepatitis),intestinal inflammation(in portal vein thrombosis and granulomatous hepatitis),metabolic impairment(in non-alcoholic fatty liver disease or cholelithiasis),or drug toxicity(in drug induced liver injury or hepatitis B virus infection reactivation).Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications,improving management and outcome.展开更多
BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus(HCV)infection.With the introduction of direct-acting antiviral agents(DAAs),sustained virological response(SVR)is a...BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus(HCV)infection.With the introduction of direct-acting antiviral agents(DAAs),sustained virological response(SVR)is achieved in more than 95%of the patients.The focus is now being turned to the global targets set by the World Health Organization,with the aim of achieving HCV elimination by 2030.Prison inmates constitute one of the high-risk groups,and receive treatment less frequently due to several barriers in access to health care.AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting,where tertial referral liver center specialists locally provide,on-site assessment and treatment for the prisoners.METHODS A prospective observational study was conducted from April 2017 to March 2020,which included all HCV monoinfected prison inmates in the largest Northern Portugal prison.Demographic,clinical,and laboratory data,as well as transient elastography measurements,were collected onsite by the medical team and prospectively recorded.Patients were treated with DAA according to international guidelines.The primary endpoint was SVR at post-treatment week 12.RESULTS There were 98 monoinfected HCV male inmates(mean age,42.7±8.6 years)included in the analysis.Injecting drugs or tattooing were reported in 74.5%,with 38.8%of the latter being done in prison.Alcohol consumption of more than 30 g/d was referred in 69.4%.The most prevalent genotype was 1a(54.1%),followed by 3(27.6%),4(9.2%)and 1b(6.1%).Pretreatment fibrosis degree was mild-tomoderate(F0-F2)in 77.6%and severe in 22.4%(F3-F4).Treatment regimens chosen were:45.9%elbasvir/grazoprevir,29.6%sofosbuvir/velpatasvir,and 12.2%sofosbuvir/ledispavir and glecaprevir/pibrentasvir.No major adverse events were observed.SVR at post-treatment week 12 was 99%.CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination,the onsite evaluation and treatment of HCV-infected prisoners,achieved an exceptional highly effective success rate.This type of collaborative program should be considered to be expanded,to support hepatitis C elimination efforts.展开更多
The global pandemic of coronavirus disease 2019(COVID-19)changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases.We performed a comp...The global pandemic of coronavirus disease 2019(COVID-19)changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases.We performed a comprehensive review about how COVID-19 can affect the liver,the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19.We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease,alcoholic liver disease,viral hepatitis,autoimmune liver disease,cirrhosis,hepatocellular carcinoma and liver transplantation,as well as the approach to SARS-CoV-2 vaccination.展开更多
文摘Hepatobiliary manifestations are common in inflammatory bowel disease(IBD),with 30%of patients presenting abnormal liver tests and 5%developing chronic liver disease.They range from asymptomatic elevated liver tests to lifethreatening disease and usually follow an independent course from IBD.The pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background(in primary sclerosing cholangitis,IgG4-related cholangitis,and autoimmune hepatitis),intestinal inflammation(in portal vein thrombosis and granulomatous hepatitis),metabolic impairment(in non-alcoholic fatty liver disease or cholelithiasis),or drug toxicity(in drug induced liver injury or hepatitis B virus infection reactivation).Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications,improving management and outcome.
文摘BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus(HCV)infection.With the introduction of direct-acting antiviral agents(DAAs),sustained virological response(SVR)is achieved in more than 95%of the patients.The focus is now being turned to the global targets set by the World Health Organization,with the aim of achieving HCV elimination by 2030.Prison inmates constitute one of the high-risk groups,and receive treatment less frequently due to several barriers in access to health care.AIM To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting,where tertial referral liver center specialists locally provide,on-site assessment and treatment for the prisoners.METHODS A prospective observational study was conducted from April 2017 to March 2020,which included all HCV monoinfected prison inmates in the largest Northern Portugal prison.Demographic,clinical,and laboratory data,as well as transient elastography measurements,were collected onsite by the medical team and prospectively recorded.Patients were treated with DAA according to international guidelines.The primary endpoint was SVR at post-treatment week 12.RESULTS There were 98 monoinfected HCV male inmates(mean age,42.7±8.6 years)included in the analysis.Injecting drugs or tattooing were reported in 74.5%,with 38.8%of the latter being done in prison.Alcohol consumption of more than 30 g/d was referred in 69.4%.The most prevalent genotype was 1a(54.1%),followed by 3(27.6%),4(9.2%)and 1b(6.1%).Pretreatment fibrosis degree was mild-tomoderate(F0-F2)in 77.6%and severe in 22.4%(F3-F4).Treatment regimens chosen were:45.9%elbasvir/grazoprevir,29.6%sofosbuvir/velpatasvir,and 12.2%sofosbuvir/ledispavir and glecaprevir/pibrentasvir.No major adverse events were observed.SVR at post-treatment week 12 was 99%.CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination,the onsite evaluation and treatment of HCV-infected prisoners,achieved an exceptional highly effective success rate.This type of collaborative program should be considered to be expanded,to support hepatitis C elimination efforts.
文摘The global pandemic of coronavirus disease 2019(COVID-19)changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases.We performed a comprehensive review about how COVID-19 can affect the liver,the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19.We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease,alcoholic liver disease,viral hepatitis,autoimmune liver disease,cirrhosis,hepatocellular carcinoma and liver transplantation,as well as the approach to SARS-CoV-2 vaccination.
