Cirrhosis update: 6 latest reports on improving prevention, management

Cirrhosis, also known as stage 4 fibrosis, is a late stage of scarring in the liver that can result from many chronic liver diseases. Currently, cirrhosis care focuses on management to avoid progression and monitoring in cases that may require liver transplantation.

Healio Gastroenterology and Liver Disease presents the following reports on the latest news in cirrhosis including the benefit of palliative care, strength training to recover from muscle mass deterioration, and a multistrain probiotic that showed improved cognitive conditions in patients with cirrhosis.

Cirrhosis Fueled by Environmental Factors, Mental Health Disorders

Liver cirrhosis, also known as the fourth and most advanced stage of fibrosis, can result from a variety of causes including nonalcoholic fatty liver disease and very often from alcohol-related liver disease — the lines of which can also be blurred.

While approximately 80 million people in the United States have some fat accumulation in their livers, the estimated number of individuals who have progressed to bridging fibrosis or cirrhosis is much lower at around 3 million. The incidence of cirrhosis and rates of death due to cirrhosis are increasing, however, due more now to diet and lifestyle choices than viral diseases. READ MORE

Palliative care would benefit patients with cirrhosis

Though 72% of patients with cirrhosis report poor quality of life, only a third receive referral to palliative care, according to an expert at the National Liver Conference 2019.

“Hepatology could benefit from a culture change relative to liver care coordination and palliative care,” Bruce A. Runyon, MD, FAASLD, special hepatology consultant to the Indian Health Services, said during his presentation. READ MORE

Physical exams, seemingly forgotten, can help diagnose cirrhosis

Despite the best medical training in the world, new trainees in hepatology often lack the primary training in giving a full physical exam, according to an expert at the National Liver Conference 2019.

“The physical exam is forgotten. My Harvard trainees, UCSF trainees, Michigan trainees came to Ship Rock and ... it’s amazing what they don’t know,” Bruce A. Runyon, MD, FAASLD, special hepatology consultant to the Indian Health Services, said during his presentation. “They just copy and paste a three-page physical exam that they didn’t do at all. No way; you have to do it.” READ MORE

Strength training ‘recovers lost muscle mass’ from cirrhosis

Supervised progressive resistance training increased muscle strength and size in patients with compensated cirrhosis while also providing beneficial effects on general performance measures, according to a study published in Clinical Gastroenterology and Hepatology.

“In cirrhosis, muscle strength and muscle mass are reduced and associated with disease severity,” Luise Aamann, MD, PhD, from the Aarhus University Hospital in Denmark, and colleagues wrote. “Nutritional supplementation can reverse muscle depletion in cirrhosis; however, nutrition is not sufficient as a sole treatment. Recovery of lost muscle strength and mass may be crucial and improve survival.” READ MORE

Models calculate risk for post-hepatectomy liver failure in cirrhosis

A pair of preoperative and postoperative models estimated the probabilities for post-hepatectomy liver failure in patients with cirrhosis, according to a recently published study.

While the safety of elective hepatectomies in patients with cirrhosis has increased in the last few decades, mortality due to post-hepatectomy liver failure (PHLF) has been reported as high as 50% along with prolonged hospitalization, increased costs and poor long-term outcomes, according to Mathieu Prodeau, MD, from the Lille University Hospital in France, and colleagues. READ MORE

Multistrain probiotic improves cognitive complications in cirrhosis

Intake of a multistrain probiotic improved cognitive function, risk for falls and inflammatory response in patients with cirrhosis and a history of cognitive impairment and previous falls, according to a study published in Hepatology Communications.

“In addition to their negative consequences for the patient, falls have implications for the patient’s relatives and are an economic and social burden for the community,” Eva Román, of the department of gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, wrote. “Moreover, individuals with previous falls are frequently predisposed to recurrent falling, thus supporting the growing concept of frailty in patients with cirrhosis and the need for preventive measures.” READ MORE