Gastroenterology Commons^™

Hemosuccus Pancreaticus As An Initial Presentation Of Decompensated Alcoholic Cirrhosis., Aamir Shahzad, Anish Paudel, Zohaib Yousaf

Tower Health Research Day

No abstract provided.

Impact Of Compensated Cirrhosis On Survival In Patients With Acute-On-Chronic Liver Failure, Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K. Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Saeed Hamid, Amna Subhan Butt

Section of Gastroenterology

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were …

Interventional Treatment With The Transjugular Intrahepatic Portosystemic Shunt (Tips) Procedure May Offer A Preferable Alternative To Systemic Anticoagulation In Patients With Cirrhosis And Portal Vein Thrombosis, Molly N. Pantelic

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Wang Z, Jiang MS, Zhang HL, et al. Is post-tips anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology. 2016;279(3):943-951. https://doi.org/10.1148/radiol.2015150369

for a patient with cryptogenic cirrhosis, gastroesophageal varices, pancreatic cancer, and portal vein thrombosis.

Diagnostic Accuracy Of The Forns Score For Liver Cirrhosis In Patients With Chronic Viral Hepatitis, Tayyaba Bukhari, Lena Jafri, Hafsa Majid, Sibtain Ahmed, Aysha Habib Khan, Shahab Abid, Aniqa Raza, Imran Siddiqui

Department of Pathology and Laboratory Medicine

Introduction: Liver cirrhosis is an irreversible and end-stage disease. It results from chronic liver damage characterized by the replacement of normal liver tissue by fibrosis, leading to the progressive loss of liver function. Making an early diagnosis of cirrhosis is important for patients with chronic hepatitis because early antiviral therapy can prevent the progression of cirrhosis and even induce regression. There have been efforts to develop surrogate markers for liver cirrhosis as the biopsy is invasive, costly, and difficult to standardize.
Methods: This was a cross-sectional study conducted at the Section of Chemical Pathology, the Department of Pathology and Laboratory …

Changing Population Of Liver Transplant Recipients In The Era Of Direct-Acting Antiviral Therapy, Chencheng Xie, Yong-Fang Kuo, Ashwani K Singal

Division of Gastroenterology and Hepatology Faculty Papers

Background and Aims: With the availability of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection and changing liver disease etiology for liver transplantation (LT), data on the changes in LT recipient population in the DAA era are scanty. Methods: The United Network for Organ Sharing (UNOS) registry (01/2007 to 06/2018) was used to develop a retrospective cohort of LT recipients for HCV, alco-hol-associated liver disease (ALD), and non-alcoholic steato-hepatitis (NASH). LT recipients in the DAA era (2013-2018) were compared with those in the pre-DAA era (2007-2012) era for recipient characteristics. Chi-square and analysis of variance were the statistical …

Acute-On-Chronic Liver Failure: Consensus Recommendations Of The Asian Pacific Association For The Study Of The Liver (Apasl): An Update, Shiv Kumar Sarin, Ashok Choudhury, Manoj K. Sharma, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Saeed Hamid, Amna S. Butt, Wasim Jafri, Zaigham Abbas

Section of Gastroenterology

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during …

Endoscopic Retrograde Cholangiopancreatography In Cirrhosis - A Systematic Review And Meta-Analysis Focused On Adverse Events, Harmeet Singh Mashiana, Banreet Dhindsa, Ji Won Yoo, Amaninder Singh Dhaliwal, Shailender Singh, Harlan Sayles, Qing Wu, Ali A. Siddiqui, Gordon Ohning, Mohit Girotra, Douglas A. Adler

School of Medicine Faculty Publications

AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events. METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017. RESULTS A total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and 89% …

Assessment Of Malnutrition In Patients With Liver Cirrhosis Using Protein Calorie Malnutrition (Pcm) Score Verses Bio-Electrical Impedance Analysis (Bia), Om Parkash, Wasim Jafri, S. M. Munir, Romaina Iqbal

Section of Gastroenterology

Objective: Malnutrition is a common problem in patients with liver cirrhosis and tools for nutritional assessment are under debate. We conducted this study to assess prevalence of malnutrition in cirrhotic patients using PCM score and BIA. Additionally we compared BIA to PCM score for detecting malnutrition in this patient population.

Results: This was a cross sectional study conducted in two tertiary care hospitals of Karachi Pakistan on adults with liver cirrhosis. Malnutrition was assessed by PCM score using anthropometric measurements and biological specimens and (ii) Body cell mass was assessed using BIA. Malnutrition as estimated by the PCM score was …

It Is Reasonable To Treat Patients With Type 1 Hepatorenal Syndrome With Midodrine And Octreotide, William Kane

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Esrailian E, Pantangco ER, Kyulo NL, Hu KQ, Runyon BA. Octreotide/midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome. Dig Dis Sci. 2007;52(3):742-748. doi: 10.1007/s10620-006-9312-0

Next Big Threat For Pakistan Hepatocellular Carcinoma (Hcc), Om Parkash, Saeed Hamid

Section of Gastroenterology

In our country, world hepatitis day (28th May 2013) was observed as a liver cancer day to draw global attention on the global health menace caused by Hepatocellular carcinoma (HCC). This is the right time to write a review article to apprise the nation of this growing burden of HCC caused most commonly by viruses in our country. Pakistan is also recognized as one of the countries of the world where hepatitis C virus (HCV) is endemic. Recent large national surveys suggest an overall HCV prevalence of 4.8% and that of HBV as 2.5%. There are however communities where the …

Electrophysiological Changes In Patients With Liver Cirrhosis In A Tertiary Care Hospital In Karachi, Pakistan, Om Parkash, Ghulam Rehman Mohyuddin, Adil Ayub, Irfan Nazir, Arslan Arif Maan, Saeed Hamid

Section of Gastroenterology

Background: Electrophysiological changes in cirrhosis are well known but least investigated especially in our country hence we wanted to see electrophysiological changes especially QT interval in cirrhotic patients.

Methods: A cross-sectional study was conducted at Aga Khan University Hospital Karachi (AKUH) in which medical records (duration 2008-2010) of cirrhotic patients were reviewed.

Results: Three hundred and eighty cirrhotic patients' charts were studied, 227 (59.7 %) were male and mean age of this cohort was 52.8±12.6 years. The most common cause for CLD was Hepatitis C (CHC) in 260 (68.4%), NBNC in 56(14.7%) and HBV in 51 (13.4%). Only 225 …

Hereditary Hemochromatosis., Om Parkash, Muhammad Akram

Department of Medicine

Objective: To describe the clinical and laboratory features of hereditary hemochromatosis associated liver disease in a tertiary care hospital.

Study Design: Observational study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to October 2012.

Methodology: Charts of patients with Hereditary Hemochromatosis (HHC) were reviewed. Data collected and analyzedconsisting of clinical presentations, liver function tests, serum ferritin, transferrin saturation, hepatic imaging and histologyin patients with HHC.

Results: A total of 22 patients were identified as having hemochromatosis. All subjects were men with a mean age of 53 ± 9.2 years at the time of diagnosis. …

Role Of Non-Selective Beta Blockers In Hepatocellular Carcinoma: An Analysis In Patients With Cirrhosis And Portal Hypertension, Hiren Patel, Abhishek Kumar, Nihar Shah Md, Ela Eris, Michael Maroules, Walid J. Baddoura, Vincent A. Debari

Gastroenterology

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the …

Frequency Of Poor Quality Of Life And Predictors Of Health Related Quality Of Life In Cirrhosis At A Tertiary Care Hospital Pakistan, Om Parkash, Romaina Iqbal, Fatima Jafri, Iqbal Azam, Wasim Jafri

Section of Gastroenterology

Background

Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan.

Findings

This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with …

Short Course Adjuvant Terlipressin In Acute Variceal Bleeding: A Randomized Double Blind Dummy Controlled Trial, Zahid Azam, Saeed Hamid, Wasim Jafri, Mohammad Salih, Zaigham Abbas, Shahab Abid, Hasnain Shah

Section of Gastroenterology

Background & Aims: Terlipressin is recommended for 3-5 days as adjuvant to endoscopic variceal band ligation (EVBL) in esophageal variceal bleeding (EVB). We assessed whether terlipressin can be administered for a shorter period of time to Patients with EVB.

Methods: All eligible EVB Patients received 24 h of open label terlipressin at presentation. After successful EVBL, Patients were randomized to receive active or dummy terlipressin for the next 48 h. We excluded Patients with failure to achieve initial hemostasis, bleeding gastric varices, known hepatoma, and/or portal vein thrombosis, advanced cirrhosis (Child-Pugh score >= 12), and Patients on a ventilator. …

Non-Contrast Mri May Predict Safety Of Gadolinium-Enhanced Mri In Patients With Cirrhosis, Jonathan M. Fenkel, Md, Colin L. Smith, Md, Leela Nayak, Md, Steven K. Herrine, Md, Donald G. Mitchell, Md

Division of Gastroenterology and Hepatology Faculty Papers

Background:

Hepatorenal syndrome (HRS) is a relative contraindication to receiving gadolinium-based contrast media secondary to risk of nephrogenic systemic fibrosis (NSF)

Patients with cirrhosis frequently undergo magnetic resonance imaging (MRI) for hepatocellular cancer screening and liver transplant evaluation.

Most centers require documented serum creatinine levels within 10-14 days of performing MRIs on patients with cirrhosis.

Ascites can be readily detected on MRI without contrast enhancement.

Objective:

To determine whether the presence of ascites on MRI can be used to recommend against a diagnosis of HRS without knowledge of a serum creatinine level.

Precipitating Factors And The Outcome Of Hepatic Encephalopathy In Liver Cirrhosis, Khalid Mumtaz, Umair Syed Ahmed, Shahab Abid, Noshaba Baig, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality.

Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007.

Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p < 0.05.

Results: Of the 404 patients 252 (62%) …

Model For End-Stage Liver Disease (Meld) Score As A Useful Prognostic Marker In Cirrhotic Patients With Infection, Rustam Khan, Shahab Abid, Wasim Jafri, Safia Awan, Saeed Hamid, Hasnain Shah, Shahid Pervez

Section of Gastroenterology

OBJECTIVE: To determine the association of Model for End stage liver disease (MELD) score to the outcome of cirrhotic patients with bacterial infection and to compare it with Child-Turcott-Pugh (CTP) score.

STUDY DESIGN: Descriptive study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007.

METHODOLOGY: Patients with diagnosis of liver cirrhosis and bacterial infection were included. Demographic features, laboratory data and type of infection were recorded. Multiple logistic regression assays were applied to determine the factors associated with poor outcome in cirrhotics with infection. Receiver-Operating Characteristics (ROC) were used to determine the …