Perioperative Risk in Patients With Cirrhosis

G&H Why do patients with cirrhosis have an increased risk of perioperative morbidity and mortality? KJ Patients with cirrhosis typically have hepatocellular dysfunction and portal hypertension, […]

Frailty, Sarcopenia, and Nutrition in Patients With Cirrhosis

G&H Why is it important to identify frailty and sarcopenia in patients with cirrhosis? JL Frailty and sarcopenia are unfortunately prevalent in patients with cirrhosis. Up […]

Advances in the Management of Renal Dysfunction in Patients With Cirrhosis

Abstract: Renal dysfunction frequently develops in patients with advanced liver disease. Renal dysfunction in this setting is associated with adverse outcomes and an unfavorable prognosis. Hepatorenal […]

Smoking and Liver Disease

Abstract: Cigarette smoking is the leading cause of preventable disease and death in the United States, causing approximately 480,000 deaths per year, which is equivalent […]

Thrombocytopenia in Chronic Liver Disease and the Role of Thrombopoietin Agonists

Abstract: Thrombocytopenia is a common complication of chronic liver disease and creates clinical challenges for patients who need invasive procedures. Options available to increase platelet […]

Gastro-Hep News

Liquid Biopsies Show Potential in Detecting Early-Stage Hepatocellular Carcinoma in Patients With Hepatitis B Virus Infection Liquid biopsies, based on a combination of cell-free DNA (cfDNA) […]

Diagnostic and Treatment Implications of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

Abstract: Nonalcoholic fatty liver disease (NAFLD) affects 75 to 100 million adults in the United States and is the leading cause of chronic liver disease […]

Treatment of Portopulmonary Hypertension With Macitentan in Patients With Cirrhosis

G&H What is the current understanding of the relationship between pulmonary hypertension and cirrhosis? MK Any liver disease or vascular problem in the liver can […]

Care of Patients Following Cure of Hepatitis C Virus Infection

Abstract: The vast majority of persons with chronic hepatitis C virus (HCV) infection will achieve virologic cure with the current direct-acting antiviral therapies. Prevention of […]

Primary Sclerosing Cholangitis, Part 2: Cancer Risk, Prevention, and Surveillance

Abstract: Primary sclerosing cholangitis (PSC) is a chronic, fibroinflammatory, progressive cholangiopathy. In a clinically significant proportion of patients, the disease course of PSC is […]

The Effect of Transjugular Intrahepatic Portosystemic Shunt on Platelet Counts in Patients With Liver Cirrhosis

Abstract: Thrombocytopenia is a well-known complication of liver cirrhosis. Although the pathogenesis of thrombocytopenia is not well understood, splenic congestion resulting from portal hypertension is […]

Bariatric Surgery and Liver Transplantation

Abstract: Obesity is an important public health and medical concern in the United States. The rate of obesity has steadily risen for the past several […]

Direct-Acting Antiviral Agents in Patients with Hepatitis C Cirrhosis

Patients with cirrhosis who are infected with hepatitis C virus (HCV) are the most in need of antiviral treatment. Virologic cure improves fibrosis and quality of life while reducing liver-related morbidity and mortality. In mid-2011, the addition of direct-acting antiviral agents (DAAs)—the protease inhibitors boceprevir (Victrelis, Merck) and telaprevir (Incivek, Vertex)—to pegylated interferon a-2a/b and ribavirin revolutionized the treatment of HCV infection by increasing cure rates across all fibrosis scores in patients with genotype 1 HCV infection. However, patients with advanced fibrosis or cirrhosis are the most difficult to treat, and the addition of DAAs increases treatment side effects as well as potency. Five phase III DAA trials have been published to date, but they contain limited data on patients with cirrhosis. This review will examine the available data and will describe the evolution of HCV therapy in patients with cirrhosis from the standard-of-care therapy of the past decade into the new era of DAAs

The Current Economic Burden of Cirrhosis

Abstract: Cirrhosis is a worldwide problem that is associated with a substantial economic burden. Hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and alcoholic liver disease are the main causes of cirrhosis, but cost-effective preventive strategies are only available for HBV infection. Treatment algorithms for HBV infection and HCV infection are numerous and may be economically advantageous, depending on the regimen utilized; however, effective treatment for alcoholic liver disease is lacking, with abstinence from alcohol consumption continuing to be the main treatment strategy. In addition, liver transplantation (the only cure for cirrhosis) continues to consume substantial economic resources despite a recent reduction in overall cost. More sensitive predictors of post–liver transplantation disability could reduce this cost by allowing interventions that would promote productivity and increase health-related quality of life after liver transplantation. This paper highlights recent publications that evaluate the cost-effectiveness of strategies that prevent or treat the main causes of cirrhosis as well as publications that assess the impact of quality of life on the overall cost burden of the disease.