Publications by authors named "Alvaro Giraldez"
Novel approaches in the medical management of compensated cirrhosis.
Expert Rev Gastroenterol Hepatol
June 2024
Article Synopsis
- This review focuses on improving the care for compensated cirrhotic patients, as previous guidelines mainly addressed decompensated patients in clinical settings.
- It examines recognition and management of liver function, portal hypertension, and complications like covert hepatic encephalopathy, along with a look at extrahepatic issues and palliative care, utilizing evidence-based practices.
- The authors argue for a more comprehensive approach to treatment that goes beyond standard monitoring and imaging to address overlooked aspects of cirrhosis care.
Background & Aims: Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for high-risk acute variceal bleeding (AVB; i.e., Child-Turcotte-Pugh [CTP] B8-9+active bleeding/C10-13).
View Article and Find Full Text PDFBackground & Aims: Alcohol-related hepatitis (AH) encompasses a high mortality. AH might be a concomitant event in patients with acute variceal bleeding (AVB). The current study aimed to assess the prevalence of AH in patients with AVB and to compare the clinical outcomes of AH patients to other alcohol-related liver disease (ALD) phenotypes and viral cirrhosis.
View Article and Find Full Text PDFBackground: A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown.
View Article and Find Full Text PDFBackground: Sorafenib constitutes a suitable treatment alternative for patients with advanced hepatocellular carcinoma (HCC) in whom atezolizumab + bevacizumab therapy is contraindicated. The aim of the study was the identification of a miRNA signature in liquid biopsy related to sorafenib response.
Methods: miRNAs were profiled in hepatoblastoma HepG2 cells and tested in animal models, extracellular vesicles (EVs), and plasma from HCC patients.
Article Synopsis
- Antibiotic prophylaxis is effective in reducing infection and mortality risks in patients with cirrhosis experiencing acute variceal bleeding (AVB), but bacterial infections still occur during hospitalization.
- A study analyzed data from over 2,100 patients to assess the incidence of infections and found that about 19% developed infections, mainly respiratory ones, despite receiving antibiotics, with respiratory infections appearing early after admission.
- Key risk factors linked to higher chances of respiratory infections included advanced liver disease (Child-Pugh C), severe hepatic encephalopathy, and certain medical procedures like intubation or nasogastric tube placement.
Article Synopsis
- The study analyzed data from 843 patients with drug-induced liver injury (DILI) in Spain over 20 years to understand the clinical features and outcomes of DILI cases.
- Findings indicated that younger age and lower platelet counts were associated with hepatocellular injury, with anti-infectives being the most common drugs involved.
- The research highlighted that elevated aspartate aminotransferase (AST) levels at onset are significant predictors of poor outcomes, particularly in older patients and those with existing liver conditions.
Introduction: the aim of this study was to describe the trends of colorectal cancer (CRC) mortality by autonomous communities (ACs) and gender in Spain (1980-2018).
Methods: the age-standardized mortality rates (ASMRs) for CRC (per 100,000) were calculated by direct standardization, using the world standard population. Mortality trends were described by ACs using a joinpoint regression model in both sexes.
Background & Aims: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date.
Methods: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015.
Article Synopsis
- - Patients with acute variceal bleeding (AVB) and severe liver dysfunction (Child-Pugh C score) are at a higher risk of treatment failure and death, leading to the consideration of preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) to improve survival outcomes.
- - A study involving 671 high-risk patients revealed that p-TIPS significantly reduced mortality in Child-Pugh C patients compared to traditional treatment methods, while it showed low mortality rates in Child-Pugh B patients even without p-TIPS.
- - The findings suggest that p-TIPS should be prioritized for Child-Pugh C patients experiencing AVB, and it may also benefit some Child-Pugh B patients at
Background & Aims: Antiviral therapy for the treatment of hepatitis C (HCV) infection has proved to be safe and efficacious in patients with cirrhosis awaiting liver transplantation (LT). However, the information regarding the clinical impact of viral eradication in patients on the waiting list is still limited. The aim of the study was to investigate the probability of delisting in patients who underwent antiviral therapy, and the clinical outcomes of these delisted patients.
View Article and Find Full Text PDFBackground And Aims: Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype (GT)-1 and GT-4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients.
View Article and Find Full Text PDFCeliac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. The key treatment in these patients is a gluten-free diet, because most complications are more common when dietary compliance is poor. The most serious complication of celiac disease is the development of neoplasms (the most common of which is enteropathy-associated T-cell lymphoma).
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