This article is more than 5 years old. Information may no longer be current.

Liver disease highlights from ACG 2018

This year at the American College of Gastroenterology Annual Meeting, several hepatology specialists discussed the changing landscape of liver disease health care, such as increasing rates of nonalcoholic fatty liver disease which is quickly becoming the number one indication for liver transplantation.

Healio presents the following liver disease highlights from ACG 2018 including an improved liver biopsy attenuation technique, the risks and course of NAFLD depending on patient demographics, and liver disease in pregnant patients.

Early liver disease detection during pregnancy key for improved outcomes

Early detection of liver-related complications and hepatic diseases in patients who are pregnant leads to reduced risks and improved outcomes for both mother and child, according to a presentation at the American College of Gastroenterology Annual Meeting.

“The first thing is recognition. Recognition is most important because early recognition allows us to take better care of our patients,” Nancy S. Reau, MD, FACG, from the Rush University Medical Center in Chicago, said during her presentation. “Liver diseases can be unique to pregnancy, but there are a lot of things that can happen to a woman with [pre-existing] liver disease who becomes pregnant, so you need to manage both directions.” Read more

Combination immunotherapy may increase liver injury risk

Patients who received treatment with multiple immunotherapy drugs had increased risks for drug-induced liver injury compared with single therapy courses, as presented at the American College of Gastroenterology Annual Meeting.

“This is a rather new subsection of drug-induced liver injury that has come to our attention since the advent of immunotherapy drugs in the treatment of various different cancers, ranging from metastatic melanoma ... to colorectal cancer and renal cell carcinoma,” Vivek Bose, MD, from the Rutgers Robert Wood Johnson Medical Group in New Jersey, said during his presentation. Read more

Black patients with ALF more likely listed for liver transplant as status-1

Black patients were more likely to be waitlisted with acute liver failure, require status-1 listing and undergo liver transplantation than white patients, according to a presentation at the American College of Gastroenterology Annual Meeting.

“Acute liver failure is a potentially fatal condition characterized by severe hepatic injury resulting in liver dysfunction and encephalopathy,” Lauren D. Nephew, MD, MSCE, from Indiana University, said during her presentation. “Our aim was to explore differences in clinical characteristics and etiologies of ALF between black and white patients waitlisted for LT.” Read more

Rifaximin reduces overt HE recurrence regardless of Child-Pugh class

Treatment with rifaximin significantly reduced the risk for overt hepatic encephalopathy among patients with cirrhosis regardless of Child-Pugh class and was overall safe and well-tolerated, according to a presentation at the American College of Gastroenterology Annual Meeting.

According to Steven L. Flamm, MD, from the Northwestern Feinberg School of Medicine in Chicago, this study was a post hoc analysis designed to determine rifaximin’s safety and efficacy by Child-Pugh subclass, as a previous phase 3 study confirmed its overall superiority to placebo in the prevention of overt hepatic encephalopathy (HE). Read more

FibroScan after endoscopy found undiagnosed NAFLD, NASH

FibroScan screening for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis could significantly improve patient diagnosis and care, as data presented at the American College of Gastroenterology Annual Meeting showed that FibroScan found a significant number of undiagnosed cases.

“Nonalcoholic fatty live disease and nonalcoholic steatohepatitis are largely undiagnosed until later stages in which symptoms appears,” Woodie M. Zachry III, PhD, RPh, from Quantym Therapeutic Data in Florida, said during his presentation. “This sets up a paradigm that early detection and intervention are necessary.” Read more

VIDEO: Future of liver transplant points to changing indications, allocation

In this exclusive video perspective from the American College of Gastroenterology Annual Meeting, Paul Y. Kwo, MD, FACG, from Stanford University in California, provides an overview of the changing landscape in liver transplantation and what to expect in the coming years.

“One of the things that’s most interesting about liver transplantation is that the demographics of those who are getting transplanted is changing,” Kwo told Healio Gastroenterology and Liver Disease. “For many decades, the number one indication worldwide for liver transplantation has been hepatitis C-related cirrhosis, but with the marked advances we’ve had in direct-acting antiviral agents now two other diseases are replacing [HCV] and they are alcohol-related liver disease and nonalcoholic fatty liver disease.” Read more

Vosevi safe, effective in ‘triple-infected’ patients with HCV, HBV, HIV

The direct-acting antiviral Vosevi demonstrated an average sustained virologic response rate of 87% among patients who were “triple-infected” with hepatitis C genotype 3, hepatitis B and HIV, as presented at the American College of Gastroenterology Annual Meeting.

“Chronic hepatitis C treatment is no longer challenging in the era of DAAs with an SVR of up to 97%. However, triple infection treatment with HCV, HIV and hepatitis B has not been explored in real life situations,” Nimy John, MD, from the University of Massachusetts Medical School, said during her presentation. Read more

Liver biopsy with three actuations provides superior tissue yields

Endoscopic ultrasound-guided liver biopsy using three fanning needle motions provided superior tissue yields than a single needle throw, according to a presentation at the American College of Gastroenterology Annual Meeting.

“Liver biopsy remains the gold standard in the evaluation and management of liver disease,” Rafael Ching-Companioni, MD, from the Geisinger Medical Center in Pennsylvania, said during his presentation. “Recently, several reports have validated liver biopsy to be a safe and effective technique for achieving parenchymal liver biopsy. Our aim was to compare one and three needle actuations.” Read more

NAFLD has ‘bidirectional’ course in patients with type 2 diabetes

Nonalcoholic fatty liver disease may have a “bidirectional” nature in patients with type 2 diabetes as NAFLD regressed in 2.2% of patients without any NAFLD-specific interventions despite increase in the prevalence of risk factors, according to a presentation at the American College of Gastroenterology Annual Meeting.

“With increasing prevalence of metabolic syndrome, prevalence of NAFLD has increased,” Amandeep Singh, MD, from Stanford University in California, said during his presentation. “NAFLD is projected to be the most common indication for liver transplantation in coming years and diabetes is a major risk factor for progressive disease in NAFLD patients.” Read more