Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era.

Background: Salvage transjugular intrahepatic portosystemic shunts (TIPS) are associated with poor prognosis, especially in patients with Child-Pugh C cirrhosis. Since preemptive TIPS improved prophylaxis of variceal bleeding in those patients, recourse to salvage TIPS may now affect patients with a better prognosis.

Aim: To assess the impact of the preemptive TIPS policy on outcomes after salvage TIPS placement.

Recalibrated MELD and hepatic encephalopathy are prognostic factors in cirrhotic patients with acute variceal bleeding.

Background & Aims: Early TIPS placement must be considered in patients with Child-Pugh B and active bleeding at endoscopy or in patients with Child-Pugh C 10-13 and variceal bleeding. However, active bleeding at endoscopy is a subjective criterion. Moreover, a previous study has shown that a MELD-based score accurately predicted 6-week mortality and helped to stratify patients.

Multicenter prospective validation of the Baveno IV and Baveno II/III criteria in cirrhosis patients with variceal bleeding.

Unlabelled: The criteria for defining failure to control bleeding in cirrhosis patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI=number of blood units/(final-initial hematocrit+0.

[Predictors of osteopenic syndrome in idiopathic pulmonary fibrosis].

Aim: To evaluate the functional state of bone tissue in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation, and to determine possible predictors of lower bone mineral density (BMD) in this pathology in the pretransplantation period.

Subjects And Methods: Forty-nine IPF patients waiting for lung transplantation were examined. The patients' mean age was 53.

Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?

Background: Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients.

Aim: To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis.

Methods: We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011.

Optimal nonsurgical management of peptic ulcer bleeding, including arterial embolization is associated with a mortality below 1%.

Background: Management of high-risk peptic ulcer bleeding (PUB) consists in a high-dose infusion of proton pump inhibitors (PPIs) with double endoscopic treatment. If bleeding recurs, a second endoscopic treatment is required. Surgical management should be performed in case of endoscopic treatment failure, or if a second rebleeding occurs.

[Association between adipokines and the development of osteopenic syndrome in end-stage lung disease].

Aim: To study of an association between adipokines, nutritional status, and bone mineral density (BMD) in end-stage lung disease (ESLD).

Subjects And Methods: Forty-seven patients aged 26 to 62 years with ESLD were examined. BMD in the lumbar spine (L(II)-L(IV)) and left femoral neck (FN) was estimated using dual-energy X-ray absorptiometry (DXA).

Biomarkers of liver injury for hepatitis clinical trials: a meta-analysis of longitudinal studies.

Background: Liver biopsy and virological end points are standard references for assessing the effect of viral hepatitis treatments. We aimed to review evidence-based published data of biomarkers that have been validated as non-invasive alternatives to biopsy as end points for HBV and HCV infection trials.

Methods: Studies were included if there were at least two repeated estimates of fibrosis per patient using biomarkers with at least two studies and a control group.

CYP2C9*3 Loss-of-Function Allele Is Associated With Acute Upper Gastrointestinal Bleeding Related to the Use of NSAIDs Other Than Aspirin.

Nonsteroidal anti-inflammatory drugs (NSAIDs), other than aspirin, are to some extent metabolized by cytochrome P450 2C9 (CYP2C9). The CYP2C9 359Leu (CYP2C9*3) loss-of-function allele could be a risk factor for acute upper gastrointestinal bleeding (AUGIB) related to the use of NSAIDs other than aspirin. To test this hypothesis, we performed a prospective, multicenter, case-case study in patients hospitalized for AUGIB related to the use of NSAIDs.

Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest).

Background: FibroTest and elastography have been validated as biomarkers of liver fibrosis in the most frequent chronic liver diseases and in the fibrosis screening of patients with diabetes. One challenge was to use them for estimating the prevalence of fibrosis, identifying independent risk factors and to propose screening strategies in the general population.

Methods: We prospectively studied 7,463 consecutive subjects aged 40 years or older.

Assessment of adrenal function in cirrhotic patients: salivary cortisol should be preferred.

Background & Aims: Adrenal insufficiency is a common disorder among cirrhotic patients. Adrenal function is usually assessed with serum total cortisol assays. Free cortisol (active fraction) represents only 10% of serum total cortisol, the remaining 90% being linked to cortisol-binding globulin (CBG) and albumin.

[Intracardiac hemodynamics in patients with isolated chronic obstructive pulmonary disease and coronary heart disease].

Analysis of intracardiac hemodynamics is presented in patients with isolated stage II, III and IV chronic obstructive pulmonary disease (COPD) in the period of exacerbation and in those having COPD with concomitant coronary heart disease (stable angina of functional class II). Retrospective evaluation included 100 medical histories. Color Doppler echoCG was performed and parameters of systolic and diastolic function of both ventricles measured.

Impact of interferon-alpha treatment on liver fibrosis in patients with chronic hepatitis B: an overview of published trials.

Background: The impact of interferon treatment in patients with hepatitis B virus (HBV) infection on fibrosis progression in comparison with its natural history has yet to be assessed in any large-scale randomized studies. The present report is a review of the evidence-based data published so far.

Methods: Studies were included if they had at least two repeated estimates of liver fibrosis per patient treated with interferon-alpha (whether pegylated or not).

Assessment of liver fibrosis: noninvasive means.

Liver biopsy, owing to its limitations and risks, is an imperfect gold standard for assessing the severity of the most frequent chronic liver diseases chronic hepatitis C (HCV), B (HBV) non alcoholic (NAFLD) and alcoholic (ALD) fatty liver diseases. This review summarizes the advantages and the limits of the available biomarkers of liver fibrosis. Among a total of 2,237 references, a total of 14 validated serum biomarkers have been identified between 1991 and 2008.

Methodological aspects of the interpretation of non-invasive biomarkers of liver fibrosis: a 2008 update.

This review summarizes the methodological aspects of the interpretation of non-invasive biomarkers in liver fibrosis. A scoring system has been updated to better compare the quality of fibrosis biomarkers. Several methodological issues are related to the classical methodology using biopsy, as this is considered the gold standard.

Biomarkers of liver fibrosis.

Liver biopsy, due to its limitations and risks, is an imperfect gold standard for assessing the severity of the most frequent chronic liver diseases. This chapter summarized the advantages and the limits of the available biomarkers of liver fibrosis. Among a total of 2237 references, a total of 14 validated biomarkers have been identified between 1991 and 2007.

[Treatment of chronic hepatitis B in HIV co-infected patients].

Because of complex interactions between HIV, hepatitis B virus (HBV), immune system and antiretrovirals, treatment of HBV infection in HIV population should consider both viruses. In co-infected patients with no indication of antiretrovirals, drugs with dual activity against HBV and HIV are not recommended to avoid development of HIV resistance (lamivudine, emtricitabine, entecavir, tenofovir disoproxil fumarate). Adefovir dipivoxil or pegylated interferon may be used.

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial.

Unlabelled: A beneficial effect of recombinant activated factor VII (rFVIIa) in Child-Pugh class B and C patients with cirrhosis who have variceal bleeding has been suggested. This randomized controlled trial assessed the efficacy and safety of rFVIIa in patients with advanced cirrhosis and active variceal bleeding. At 31 hospitals in an emergency setting, 256 patients (Child-Pugh > 8; Child-Pugh B = 26%, C = 74%) were randomized equally to: placebo; 600 microg/kg rFVIIa (200 + 4x 100 microg/kg); or 300 microg/kg rFVIIa (200 + 100 microg/kg).

Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure.

Unlabelled: Although it is often functional at presentation, acute renal failure has a poor prognosis in patients with cirrhosis. The role of inflammation, a key event in the outcome of cirrhosis, has never been studied in this setting. We aimed to investigate the predictive factors of mortality in patients with cirrhosis and acute functional renal failure, specifically in relation to inflammatory events.

Continuous infusion of high-dose omeprazole is more effective than standard-dose omeprazole in patients with high-risk peptic ulcer bleeding: a retrospective study.

Unlabelled: High-dose omeprazole reduces the rate of recurrent bleeding after endoscopic treatment of peptic ulcer bleeding. However, the effectiveness of high-dose vs. standard-dose omeprazole in peptic ulcer bleeding has never been shown.

Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series.

Background: Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis.