8 recent reports on prevention, prediction of cirrhosis

Chronic liver damage known as cirrhosis has a variety of causes. What remains constant is its potential progression to liver failure. Researchers continue to seek verifiable methods to prevent the development of cirrhosis firstly and, secondly, to predict its progression or involvement to worse conditions such as liver cancer, coronary artery disease or hepatic encephalopathy.

The following reports include recent data on diet and coffee as beneficial in cirrhosis, cases in which cirrhosis led to worse prognoses in other conditions, and treating cirrhosis in patients with comorbidities.

Middle Eastern diet increases gut microbiota diversity, shows benefit in cirrhosis

Diets with a high intake of vegetables, cereals, coffee, tea and fermented milk products like yogurt correlated with a higher diversity in the gut microbiome. In turn, a higher microbial diversity correlated with a lower risk for hospitalization among patients with cirrhosis, according to recently published data.

“We wanted to know why cirrhosis is so much more commonly a cause of death in some countries and why the disparities between populations exist,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University, told Healio Gastroenterology and Liver Disease. “Specifically, in the United States, cirrhosis as a cause of death is quite high, whereas it is not as high in some Middle Eastern countries like Turkey. We hypothesized that this could be because of the gut microbes and diet, which are clearly different in patients from these countries. Read more

Moderate coffee intake reduces risk for liver cancer, cirrhosis, fibrosis

In a roundtable format, experts gathered to discuss the latest research on coffee and liver disease, which indicate that drinking approximately three to five cups per day is associated with a reduced risk for hepatocellular carcinoma, cirrhosis and fibrosis.

“I’ve been in the field for 30-odd years and it’s not a topic that’s come up until very recently. I would imagine patients will always ask, ‘What can I do to help myself?’ And the advice is always lose weight, don’t drink too much alcohol and don’t smoke at all — a lot of advice that is somewhat negative,” Graeme Alexander, MD, senior advisor to the British Liver Trust, told Healio Gastroenterology and Liver Disease. “But to be told something positive, rather than negative, is a good message. If people ask, ‘Should I drink coffee?’ the answer would be yes.” Read more

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NASH cirrhosis treatment successful in patients without esophageal varices

Galectin Therapeutics announced that its proprietary compound GR-MD-02 significantly reduced hepatic venous pressure gradient in patients with nonalcoholic steatohepatitis-related cirrhosis without esophageal varices in a recent phase 2b trial.

“Patients with cirrhosis without varices is both an easily identifiable population and the population that you want to focus on for treatment because they’re not so far gone that they are going to have complications right away from their cirrhosis,” Peter G. Traber, MD, president and CEO of Galectin, told Healio Gastroenterology and Liver Disease. “But they have cirrhosis, and if you don’t treat them, they will progress.” Read more

Child-Pugh B, C scores predict failure in liver cancer surveillance

Child-Pugh B and C, and elevated alpha-fetoprotein, at diagnosis of hepatocellular carcinoma corresponded with a diagnosis outside Milan criteria and surveillance failure during a surveillance program of patients with cirrhosis.

“HCC surveillance in cirrhotic patients aims to detect tumors in the initial stages of the disease to offer treatments that increase patient survival,” Alejo Mancebo, MD, from the Hospital Universitario Central de Asturias, Spain, and colleagues wrote. “Although the usefulness of screening programs remains controversial, several studies have shown survival improvement in patients under surveillance.” Read more

NASH, HCV cirrhosis predict coronary artery disease in liver transplantation

Patients who underwent liver transplantation evaluation had a high prevalence of coronary artery disease, especially those with nonalcoholic steatohepatitis-related cirrhosis, hepatitis C-related cirrhosis and alcoholic cirrhosis, according to a recently published study.

“An integral component of the liver transplant evaluation (LTE) is coronary artery disease (CAD) assessment as surgical morbidity and mortality can be as high as 81% and 50%, respectively, in patients with significant CAD undergoing LT,” Samarth S. Patel, MD, from the Virginia Commonwealth University, and colleagues wrote. “We conducted the following study to describe the distribution of CAD noted on per-protocol coronary angiography in patients undergoing LTE, risk factors associated with CAD and complications associated with coronary angiography.” Read more

Model accurately predicts cirrhosis-driven hepatic encephalopathy

A recently published study reports on the development of two risk-score models to predict the 1-year and 5-year probability for hepatic encephalopathy in patients with cirrhosis, based on statin use and total bilirubin and albumin.

“We found that the risk of [hepatic encephalopathy] in patients with cirrhosis can be stratified by two readily available lab tests and a brief inventory of the medication list,” Elliot B. Tapper, MD, from the department of gastroenterology and hepatology, University of Michigan, and colleagues wrote. “The potential benefits of statins in preventing [hepatic encephalopathy] need to be studied in rigorously designed randomized controlled trials. This is particularly important for patients with cirrhosis for whom there is no effective treatment to eliminate or control the underlying cause.” Read more

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Immunosuppression, cirrhosis decrease SVR rates in HIV/HCV coinfection

Direct-acting antiviral therapy was safe and highly effective in patients coinfected with HIV and hepatitis C, according to study results from the Madrid Coinfection Registry, or Madrid-CoRe. Factors that negatively affected sustained virologic response rates included HIV-related immunosuppression, HCV RNA load, severity of liver disease and suboptimal DAA-based regimens.

“This huge sample provided by Madrid-CoRe gave us the opportunity to assess treatment outcomes for various all-oral DAA regimens against several genotypes in different categories of liver disease and to evaluate predictors of treatment response, which are difficult to determine for such a highly successful therapy,” Juan Berenguer, MD, PhD, from the Hospital General Universitario Gregorio Marañón, Spain, told Healio Gastroenterology and Liver Disease. “It is also of note that, our multivariable model showed that the probability of failure was highest for decompensated cirrhosis, intermediate for compensated cirrhosis, and lowest for the absence of cirrhosis, with statistically significant pair-wise comparisons between the three groups.” Read more

Psoriasis, inflammatory diseases increase risk for cirrhosis, fatty liver

Patients with inflammatory disorders, especially psoriasis and psoriatic arthritis, had an elevated risk for severe liver disease such as nonalcoholic fatty liver disease and cirrhosis, according to a recently published study.

“As a rheumatologist, I prescribe methotrexate a lot, and what we see in clinic often is that our patients with psoriatic arthritis tend to have a lot of liver function test abnormalities somewhat quickly after starting methotrexate. It happens in a large proportion of patients, anecdotally, in my clinic,” Alexis Ogdie, MD, MSCE, from the Perelman School of Medicine at the University of Pennsylvania, told Healio Gastroenterology and Liver Disease. “So, one of the things we were interested in was: are these patients already set up for liver disease even before methotrexate?” Read more