7 recent reports in liver: HCC screening, cirrhosis, DDW

In preparation for the International Liver Conference June 23-26, Healio Gastroenterology and Hepatology presents the following report on the latest stories in liver research.

These stories include screening for hepatocellular carcinoma, antimicrobial gene burden in cirrhosis, AGA guidance on palliative care management, coverage from Digestive Disease Week and more.

Researchers find changes in ultrasound quality for HCC screening

Ultrasound quality changed between examinations for hepatocellular carcinoma detection in patients with cirrhosis, according to research published in Clinical Gastroenterology and Hepatology.

“While ultrasound remains the most cost-effective modality for screening, there are limitations associated with its use. One of the largest criticisms of ultrasound in HCC screening is variability in sensitivity, ranging between 32% and 89% when used alone,” Haley Schoenberger, MD, from The University of Texas Southwestern Medical Center, and colleagues wrote. “Although ultrasound visualization may remain stable over time, it is possible that it may vary between ultrasound exams given its operator dependent nature.” READ MORE.

Higher antimicrobial gene burden in patients with cirrhosis vs. IBD, other diseases

Patients with cirrhosis had a higher abundance of beta-lactamase, vancomycin and quinolone resistance genes in their gut microbiota compared with patients with inflammatory bowel disease, chronic kidney disease and diabetes, according to a presentation from Digestive Diseases Week.

"What we found is alarming because it means that patients with cirrhosis may have a much higher burden of antibiotic resistance genes in their gut microbiome compared with other chronic diseases, which puts them at a greater risk for developing poor outcomes,” Jasmohan Bajaj, MD, MS, FACG, AGAF, told Healio Gastroenterology. “A combination of poor liver function, local and systemic immune response, repeated contacts with health care facilities and antibiotic use may be to blame." READ MORE.

Volume on consults for alcohol-related GI, liver diseases remain elevated throughout COVID-19

Despite ongoing COVID-19 infection control restrictions, volumes of inpatient consults for alcohol-related gastrointestinal and liver diseases had significantly decreased at the onset of the COVID-19 pandemic, but quickly returned to normal levels, according to an expert presentation during a press conference in advance of Digestive Diseases Week.

“We do believe that the lock down of the pandemic has a direct effect on patients’ alcoholic consumption,” Waihong Chung, MD, PhD, research fellow for the division of gastroenterology at the Warren Alpert Medical School of Brown University, said during his presentation. “I want to stress that many patients with alcoholic related disorders aren’t admitted to hospital right away or at all so we believe that health problems related to increased alcohol use may be even higher in a community. So, we urge primary care physicians or GI doctors and hepatologists to double down on questioning patients about their alcohol use and to identify people who might need help sooner or later.” READ MORE.

Statins underused in NAFLD patients with clear indications

Only 56% of patients with nonalcoholic fatty liver disease were taking guidelines-recommended statin therapy, according to a study published in Clinical Gastroenterology and Hepatology.

“Older patients, as well as those with dyslipidemia or hypertension, were more likely to be on a statin. Statin use decreased as NAFLD became more advanced, likely reflecting safety concerns in patients with decompensated cirrhosis,” Mary J. Thompson, MD, from the division of gastroenterology, hepatology and nutrition, University of Minnesota, and colleagues wrote. “Women were less likely to be on an indicated statin compared with men, even after adjusting for cardiovascular risk factors and liver disease severity. [This] analysis of a large national real-world sample showed that guideline-recommended statins continue to be underutilized and were not prescribed in 40% of NAFLD patients with clear indications.” READ MORE.

Graft, patient survival improves in HIV, HCC liver transplant recipients

Outcomes have improved significantly among HIV/hepatitis C virus-coinfected liver transplant recipients in the direct-acting antiviral era, according to data presented at the Digestive Disease Week.

“The practice of liver transplant for HIV-positive patients has been increasing since 2013 when the HOPE Act was passed; however, the number is still low, less than 1% of total liver transplants,” Jennifer Wang, from the University of Chicago, said during her presentation. “There is a significant geographic variation of HIV/HCV coinfected liver transplant practice with limited number of participating centers. Liver transplant outcomes for coinfected patients have improved significantly in the [direct-acting antiviral (DAA)] era and are comparable to patients without either infection.” READ MORE.

VIDEO: Cirrhosis awareness key to liver health improvement in NASH

In an exclusive video with Healio Gastroenterology, Eric Lawitz, MD, from the Texas Liver Institute, The University of Texas Health, San Antonio, spoke about the NAVIGATE trial in nonalcoholic steatohepatitis-related cirrhosis. READ MORE.

AGA issues new guidance on palliative care management in cirrhosis

The American Gastroenterological Association published a new clinical practice update on palliative care management in patients with cirrhosis.

“Associated with a high burden of physical and psychological symptoms even in the compensated state, the quality of life of patients [with cirrhosis] with worsening disease severity parallels that of patients with advanced cancer,” Puneeta Tandon, MD, MSc, division of gastroenterology at the University of Alberta in Alberta, Canada, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Despite this high symptom burden and chance for acute unexpected deteriorations in their disease course, rates of advance care planning and goals of care directives remain low, symptom management is suboptimally addressed and specialty palliative care and hospice referrals occur infrequently and late in the course of the disease.” READ MORE.

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