Hepatology highlights from DDW include microbiome, LT, HBV

Among the presentations at this year’s Digestive Disease Week, physician experts and clinical professionals discussed new data on liver disease diagnosis and treatment, including topics such as gut microbiota, liver transplantation, fatty liver disease and viral hepatitis, as well as advances in the world of telemedicine and unique approaches in patient management.

Healio.com/Hepatology presents some of the highlights from DDW 2017.

Gut microbiota associated with impaired cognitive function post-LT

Cognitive function improves in most patients who undergo liver transplantation for cirrhosis, according to a presentation at Digestive Disease Week. However, in those who do not improve, researchers have found an increase in Proteobacteria that could be associated with incomplete brain recovery for select patients.

“It is assumed that cognitive function recovers completely after liver transplant; however, this may be incomplete in some subgroups. Pre-LT gut microbiota, especially phylum Proteobacteria that includes all the bad bugs that we love to hate ... are especially linked with poor outcomes,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University, said in his presentation. “In non-cirrhotic patients, gut microbiota abnormalities are associated with changes in brain function ... however, the association of gut microbiota change on post liver transplant cognitive ability in unclear.” Read more

Older donor age negatively affects survival of living donor LT recipient

Older donor age in living donor liver transplantation negatively affected survival at 1 year and increased the risk for complications, according to a presenter at Digestive Disease Week.

“There have been studies that looked at regenerative capacity, and it has been shown that the capacity of regeneration is less in the older donor,” Wuttiporn Manatsathit, MD, from the department of gastroenterology, University of Nebraska, said in a presentation. “Our theory is that the effect of older donor in living donor liver transplant could be more prominent.” Read more

AIH, younger age increase risk for PSC recurrence in pediatric LT patients

Researchers found that nearly a quarter of pediatric patients who underwent liver transplantation for primary sclerosing cholangitis had recurrence posttransplant, particularly patients who were younger or had autoimmune hepatitis, according to a presentation at Digestive Disease Week.

“Liver transplantation is the only therapy for primary sclerosing cholangitis. Most liver transplant outcomes for children are generally good. Pediatric onset PSC and PSC with autoimmune hepatitis overlap phenotype are quite rare. Furthermore, pediatric liver transplant for PSC is quite uncommon,” Fateh Bazerbachi, MD, from the Mayo Clinic, Rochester, Minnesota said. “Our study objective was to characterize the current PSC as [indication for] liver transplant using a large, multicenter international cohort of children with this disease.” Read more

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VIDEO: Clinical text messaging useful in management of fatty liver disease

In this exclusive video from Digestive Disease Week, Ashwani K. Singal, MD, from the hepatology department at the University of Alabama, Birmingham, discusses the use of text messaging in the management of patients with fatty liver disease.

“We used the text messaging approach using a patient’s cell phone as a strategy to impact fatty liver disease outcomes and improvement of weight and other parameters of fatty liver disease like lipid enzymes and lipid profile,” Singal said. “The reason we did this study ... basically runs behind no effective therapies for this disease [existing] except weight loss of about 7% to 10%.” The impact of text messaging is documented in obesity, but has not yet been studied in patients with fatty liver disease, he added. Watch video

Modest alcohol consumption may improve survival in NAFLD patients

According to a presentation at Digestive Disease Week, modest alcohol consumption of about half to one drink of alcohol per day showed an increase in survival rates in patients with nonalcoholic fatty liver disease, while more than one and a half drinks per day was linked to an increased trend in harm.

“We don’t really know the effect of alcohol consumption in NAFLD patients,” Kaveh Hajifathalian, MD, MPH, said in his presentation. “It’s easy to assume that these are patients with chronic liver disease and that they should abstain from drinking even a drop of alcohol, but ... cardiovascular disease remains the most common cause of mortality and morbidity in these patients. There is really good evidence that modest alcohol consumption has protective effects for cardiovascular outcomes. Beyond the association with cardiovascular outcomes in NAFLD, there is also evidence for beneficial effects of alcohol in metabolic syndrome.” Read more

Cirrhosis linked to 30% of chronic HBV patients at initial presentation

In a safety-net hospital system study, researchers found that nearly 30% of patients with chronic hepatitis B had cirrhosis at initial presentation, especially men, older patients and patients with nonalcoholic fatty liver disease, according to a presentation at Digestive Disease Week.

“Delays in diagnosis potentially may be more common in underserved-type populations where there are definitely issues with access to care that might contribute to more severe disease presentation,” Robert J. Wong, MD, MS, from the Alameda Health System of Highland Hospital, Oakland, California, said in a presentation. “The aim of our study was to evaluate rates and predictors of cirrhosis and cirrhosis-related complications among adults with chronic hepatitis B among ... a diverse county hospital system.” Read more

HDV testing underused in HBV monoinfection, HBV/HIV coinfection

Researchers found that HDV testing was underused in varying patient populations, including patients with hepatitis B and patients with HBV/HIV coinfection, according to a presentation at Digestive Disease Week.

“The recommendations for testing for the delta virus are different among the different guidelines,” Parham Safaie, MD, from the University of Cincinnati, said in a presentation. “For instance, the AASLD guideline recommend testing for the delta antibody of the virus only in those individuals at risk, including subjects from high endemic areas and those with history of intravenous drug use. Whereas the EASL ... recommend for HDV, systematically, in all subjects with positive surface antigen. With that background in mind, in this work we sought to determine the frequency of testing for the delta virus among those with chronic HBV infection [and HBV/HIV coinfection].” Read more