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Gastroenterology Report 2015年第3期3卷 216-221页

作者： Yuliya Afinogenova elliot b.tapper Harvard Medical School BostonMAUSA Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA

background:Albumin is a critical component in the standard therapeutic approach to acute renal failure(ARF)and spontaneous bacterial peritonitis(SbP)in the setting of ***,data regarding the safety and minimumeffective dose are ***:We conducted a retrospective review of patients with decompensated cirrhosis who received albumin within the first 48 hours of hospitalization at beth Israel Deaconess Medical Center between 2010 and *** included 90-day risk of death or transplantation(primary)and(secondary)complications of albumin infusion(length of stay(LOS)and need for critical care),all adjusted for comorbidity and severity of ***:We included 169 patients with ARF and 88 patients with *** optimal doses of albumin for a survival benefit were found to be 87.5 g and 100 g in the ARF and SbP cohorts,*** odds ratio(OR)for the 90-day risk of death or liver transplantation associated with the optimal loading dose was 0.36(95%CI:0.17-0.76,P=0.008)and 0.28(95%CI:0.07-0.97,P=0.04)for the ARF and SbP cohorts,*** effect persisted for patients with ARF who had neither hepatorenal syndrome(HRS)nor SbP(OR:0.13,95%CI:0.007-0.79,P=0.02).LOS(beta coefficient per log albumin dose:1.69;95%CI:0.14-3.24,P=0.03)and risk of critical care(OR/g albumin:1.03;95%CI:1.01-1.05,P=0.01)were also dose ***:Albumin has a dose-dependent effect on both survival and complications in patients with cirrhosis with ARF(HRS and otherwise)and/or SbP.

关键词： albumin cirrhosis ascites hepatorenal syndrome acute renal failure spontaneous bacterial peritonitis

Interventions to improve physical function and prevent adverse events in cirrhosis

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Gastroenterology Report 2018年第1期6卷 13-20,I0001页

作者： Hirsh D.Trivedi elliot b.tapper Liver Center Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Hepatology University of MichiganAnn ArborMIUSA

Cirrhosis is associated with debilitating complications that significantly impact on a patient’s physical function and reduce quality of *** to highly prevalent sarcopenia,malnutrition and hepatic encephalopathy,functional impairment or frailty is a common complication of *** in turn increases the patient’s risk of hospitalization,accidental falls and fractures,and *** management of frailty and its associated adverse effects is imperative in improving the overall prognosis of patients with advanced liver *** cornerstone of therapy revolves around optimizing physical function with appropriate nutrition and *** therapy with protein supplementation has shown significant benefit,while studies on exercise have been ***,newly emerging studies trend towards a beneficial effect of physical exercise with improvement in quality of *** implementation of technology in liver disease management shows future *** and other wearable devices can be used to help monitor a patient’s personal progress in physical exercise and nutritional ***,the progressive development of new smartphone applications to help aid in the diagnosis and monitoring of complications of cirrhosis provides a sophisticated avenue for improving care of patients with cirrhosis.

关键词： Hepatic encephalopathy frailty sarcopenia malnutrition liver disease

Pill or procedure?Patient preferences on beta-blockers as an alternative to endoscopic variceal screening during the COVID-19 pandemic

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Gastroenterology Report 2022年第1期10卷 632-634页

作者： Zheng Che Jeremy Louissaint Ihab Kassab elliot b.tapper Department of Internal Medicine University of MichiganAnn ArborMIUSA Division of Gastroenterology and Hepatology University of MichiganAnn ArborMIUSA Gastroenterology Section VA Ann Arbor Healthcare SystemAnn ArborMIUSA

Introduction Certain patients at low risk of clinically significant esophageal varices by baveno criteria can safely avoid screening esophagogastroduodenoscopy(EGD)[1,2].However,regardless of variceal status,the PREDESCI study suggests that earlier betablocker(bb)use in compensated disease with clinically significant portal hypertension by hepatic venous pressure gradient may result in benefit by delaying the time to decompensated cirrhosis[3,4].This carries significant ramifications for future clinical guidelines and decision-making for whom we decide to initiate bb.

关键词： esophageal hepatic screening

Design and rationale of a randomized-controlled trial of home-delivered meals for the management of symptomatic ascites:the SALTYFOOD trial

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Gastroenterology Report 2019年第2期7卷 146-149,I0002页

作者： elliot b.tapper Jad baki Scott Hummel Anna Lok Division of Gastroenterology and Hepatology Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA University of Michigan Ann ArborMichiganUSA Division of Cardiology Department of Internal Medicine University of MichiganAnn ArborMichiganUSA

background:When patients with cirrhosis develop ascites,it is associated with sharply increasedmortality and healthcare utilization with decreased quality of *** salt restriction is first-line therapy for ascites but it is limited by poor ***:We will recruit 40 patients with cirrhosis and ascites who have received a recent paracentesis or hospitalization for a 1:1 randomized trial of standard care(education on salt restriction)versus home-delivered *** primary outcome is the number of paracenteses needed over 12 *** outcomes include hospital-bed days,health-related quality of life(HRQOL,Ascites Symptom Inventory-7 and Visual Analogue Scale)and performance on batteries of physical function including hand grip(kg)and walk speed(m/s).All subjects follow up through a series of calls where any paracenteses,hospital readmissions,weight changes and diuretic dosage changes are *** a final Week 12 visit,knowledge of dietary sodium intake,quality of life and frailty are reassessed,and satisfaction with the meal-delivery program is *** comparison testing will be conducted between the two ***:A nutritionally standardized meal-delivery program for patients with cirrhosis and ascites post discharge has a variety of potential patient-based benefits,including the effective management of ascites,reduction of healthcare utilization and improvement of *** have three core ***,patients will report interest in and satisfaction with a home-delivered meals ***,subjects on a salt-restricted(2 g sodium)meal-delivery program will have fewer therapeutic paracenteses and all-cause readmissions than subjects receiving standard of ***,subjects on a saltrestricted(2 g sodium)meal-delivery program will report increased HRQOL compared to subjects receiving standard of care.

关键词： Readmissions malnutrition cirrhosis nutrition sodium

Women on the liver transplantation waitlist are at increased risk of hospitalization compared to men

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World Journal of Gastroenterology 2019年第8期25卷 980-988页

作者： Jessica b Rubin Marie Sinclair Robert S Rahimi elliot b tapper Jennifer C Lai Division of Gastroenterology and Hepatology Department of MedicineUniversity of California-San FranciscoSan FranciscoCA 94143 United States Department of Gastroenterology and Hepatology Austin HealthHeidelberg 3084VictoriaAustralia Department of Medicine the University of MelbourneMelbourne 3010VictoriaAustralia Division of Hepatology Annette C.and Harold C.Simmons Transplant InstituteBaylor University Medical CenterDallasTX 75346United States Division of Gastroenterology and Hepatology University of MichiganAnn ArborMI 48109United States

bACKGROUND Hospital admissions are common among patients with cirrhosis,but patient factors associated with hospitalization have not been well *** recent data suggesting increased liver transplant waitlist dropout among women,we hypothesized that women on the liver transplant waitlist would have increased rates of hospitalization compared with *** To evaluate the role of gender on risk of hospitalization for patients on the liver transplant waitlist,in order to help explain gender disparities in waitlist *** Patients listed for liver transplant at a single center in the United States were prospectively enrolled in the Functional Assessment in Liver Transplantation *** included in this retrospective analysis included those enrolled between March 2012 and December 2014 with at least 12 mo of follow up and without hepatocellular *** primary and secondary outcomes were hospitalization and total inpatient days within 12 mo,*** and negative binomial regression associated baseline factors with *** Of the 392 patients,41%were female,with median(interquartile range)age 58 years(52-63)and model for end-stage liver disease 18(15-22).Within 12 mo,186(47%)patients were hospitalized≥1 time;48%were readmitted,with a median of 8(4-15)inpatient *** women than men were hospitalized(54%vs 43%;P=0.03).In univariable analysis,female sex was associated with an increased risk of hospitalization[odds ratios(OR)1.6,95%confidence interval(CI)1.0-2.4;P=0.03],which remained significant on adjusted multivariable analysis(OR 1.6,95%CI:1.1-2.6;P=0.03).Female gender was also associated with an increased number of inpatient days within 12 mo in both univariable and multivariable *** Women with cirrhosis on the liver transplant waitlist have more hospitalizations and inpatient days in one year compared with men,suggesting that the experience of cirrhosis differs between men and women,despite

关键词： Gender Cirrhosis Liver transplantation waitlist Hospitalization Readmission Women

Osteoporosis in primary biliary cholangitis

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World Journal of Gastroenterology 2018年第31期24卷 3513-3520页

作者： Christopher J Danford Hirsh D Trivedi Konstantinos Papamichael elliot b tapper Alan bonder Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical CenterHarvard Medical School Department of Hepatology University of Michigan

Primary biliary cholangitis(PbC) is an autoimmune cholestatic liver disease with multiple debilitating complications. Osteoporosis is a common complication of PbC resulting in frequent fractures and leading to significant morbidity in this population, yet evidence for effective therapy is lacking. We sought to summarize our current understanding of the pathophysiology of osteoporosis in PbC, as well as current and emerging therapies in order to guide future research directions. A complete search with a comprehensive literature review was performed with studies from Pub Med, EMbASE, Web of Science, Cochrane database, and the Countway Library. Osteoporosis in PbC is driven primarily by decreased bone formation, which differs from the increased bone resorption seen in postmenopausal osteoporosis. Despite this fundamental difference, current treatment recommendations are based primarily on experience with postmenopausal osteoporosis. Trials specific to PbC-related osteoporosis are small and have not consistently demonstrated a benefit in this population. As it stands, prevention of osteoporosis in PbC relies on the mitigation of risk factors such as smoking and alcohol use, as well as encouraging a healthy diet and weight-bearing exercise. The primary medical intervention for the treatment of osteoporosis in PbC remains bisphosphonates though a benefit in terms of fracture reduction has never been shown. This review outlines what is known regarding the pathogenesis of bone disease in PbC and summarizes current and emerging therapies.

关键词： biliary cirrhosis Cholestatic liver disease Osteopenia Hepatic osteodystrophy bisphosphonates Hormone replacement therapy

Nonselective beta-blocker use is associated with increased hepatic encephalopathy-related readmissions in cirrhosis

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World Journal of Clinical Cases 2022年第23期10卷 8097-8106页

作者： Mohammad Amin Fallahzadeh Sumeet K Asrani elliot b tapper Giovanna Saracino Robert S Rahimi Department of Internal Medicine Baylor University Medical CenterDallasTX 75246United States Division of Hepatology Baylor University Medical CenterDallasTX 75246United States Division of Hepatology University of MichiganAnn ArborMI 48109United States

bACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent *** beta-blockers(NSbbs)are the mainstay of pharmacologic treatment in cirrhotic *** hypothesized that since NSbbs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related *** To evaluate the impact of NSbb administration on HE-related readmissions in cirrhotic *** In this retrospective cohort study,we included 393 patients admitted to baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July *** predictors of the first HErelated readmissions were identified using Cox proportional hazards *** cumulative incidence of the first HE-related readmissions between patients receiving NSbbs and not receiving NSbbs was examined using Fine-Gray modeling to account for the competing risk of death or liver *** The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or b(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSbbs compared to patients not receiving NSbbs(71.8%vs 41.8%,Pbeta-blocker,lactulose and rifaximin use,NSbb use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 *** NSbb use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.

关键词： Altered mental status Ascites Esophageal varices Liver disease Portal hypertension Hospitalization

Medically tailored meals for the management of symptomatic ascites:the SALTYFOOD pilot randomized clinical trial

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Gastroenterology Report 2020年第6期8卷 453-456,I0002页

作者： elliot b.tapper Jad baki Samantha Nikirk Scott Hummel Sumeet K.Asrani Anna SLok Division of Gastroenterology and Hepatology University of MichiganAnn ArborMIUSA Gastroenterology Section VA Ann Arbor Healthcare SystemAnn ArborMIUSA Department of biostatistics University of MichiganAnn ArborMIUSA baylor University Medical Center DallasTXUSA

background:Ascites is a costly,morbid complication of *** a low-sodium diet is central to the clinical management of ascites,its efficacy is limited by poor *** aimed to determine the feasibility and impact of lowsodium medically tailored meals(MTM)***:We enrolled 40 persons with cirrhosis and ascites at the time of a paracentesis in a 12-week,1:1 randomized trial of standard of care(SOC)(low-sodiumdiet educational handout)or MTM with2,100 kcal,and>80 g of protein including a nocturnal protein *** determined the proportion of eligible candidates recruited and adherence to *** primary outcome was the number of paracenteses performed during weeks *** also collected ascites-specific quality-of-life(ASI-7)***:The median age of the enrolled subjects was 54(IQR,47-63)years,46%were female,with median MELD-Na 18(IQR,11-23)and albumin 2.7(IQR,2.5-3.3)g/*** baseline,subjects reported a median of two(IQR,1-3)paracenteses in the prior 4 *** to the meal schedule was excellent save for when hospitalizations *** 12 weeks,patients in the MTM arm required fewer paracenteses per week than those in the SOC group[median(IQR):0.34(0.14-0.54)vs 0.45(0.25-0.64)].During the trial,four(20%)SOC patients died,whereas two(10%)died and one(5%)was transplanted in the MTM ***-specific quality of life improved to a greater degree in the MTM arm compared to the SOC arm,by 25%(IQR,-11%to 61%)vs 13%(IQR,-28%to 54%).Conclusion:A trial of MTM for persons with ascites is feasible and potentially *** arms experienced benefits,highlighting the role for improved education and closer monitoring in this challenging condition.

关键词： cirrhosis ascites paracentesis sodium

The aspartate aminotransferase-to-platelet ratio and the evaluation of non-alcoholic fatty liver disease

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Gastroenterology Report 2014年第4期2卷 326-327页

作者： elliot b.tapper Division of Gastroenterology Beth Israel Deaconess Medical CenterBostonMass.USA

Dear Editor,We thank Agilli et *** Kayadibi et *** their interest in our manuscript[1].Taken together,their letters raise points of clarification regarding the utility and general applicability of the‘aspartate aminotransferase-to-platelet ratio index’(APRI)test in the evaluation of liver *** first comment is that their concern over confounders of the APRI unrelated to liver disease is ***,confounders would diminish the ability of APRI to predict advanced liver fibrosis,leading to false *** that our results were significant,this insight strengthens our ***,in defense of APRI,most other non-invasive predictors of liver fibrosis are vulnerable to confounding by extraneous conditions,which could instead lead to false ***‘hepascore’and‘fibrotest’,for example,utilizes bilirubin(confounded by Gilbert’s)and Gamma-Glutamyl Transferase(GGT)(confounded by cholestasis)[2].

关键词： Gilbert false utilize

Simple non-invasive biomarkers of advanced fibrosis in the evaluation of non-alcoholic fatty liver disease

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Gastroenterology Report 2014年第4期2卷 276-280页

作者： elliot b.tapper Katherine Krajewski Michelle Lai Tracy Challies Robert Kane Nezam Afdhal Daryl Lau Division of Gastroenterology Beth Israel Deaconess Medical CenterBostonMA USA Division of Radiology Beth Israel Deaconess Medical CenterBostonMAUSA Division of Pathology Beth Israel Deaconess Medical CenterBostonMAUSA

background and ***-alcoholic fatty liver disease(NAFLD)is a common,morbid disease with profound implications for the overall health of the *** set out to determine the clinical predictors of advanced histology in the referral *** performed a retrospective review of all biopsy-proven NAFLD patients,including 358 unique patients first seen between 1996 and *** histology and ultrasound images were reviewed prospectively by clinicians who were blinded to clinical information and test *** with men,women tended to present at an older age(51.4-10.6 vs 45.3-11.2 years,Pbe Caucasian(P=0.003),less likely to present with an elevated alanine aminotransferase(ALT)(75.2%vs 88.8%),and more likely to have advanced non-alcoholic steatohepatitis(NASH)(44.7%vs 29.9%;P=0.04)and advanced fibrosis(23.3%vs 14.1%;P=0.03).In multivariate logistic regression,body mass index(bMI)-30 kg/m^(2)(odds ratio(OR)2.21;95%confidential interval(CI):1.23–4.08),female gender(OR 1.76;95%CI:1.01–3.10)and aspartate aminotransferase(AST)>40 IU/L(OR 2.00;95%CI:1.14–3.55)were associated with a NAFLD activity score>*** sensitivity and specificity of an AST to platelet ratio index(APRI)>1 for significant fibrosis was 30.0%(95%CI:17.2–45.4%)and 92.8%(95%CI:88.2-95.8%),respectively;the likelihood ratio is *** multivariate logistic regression,APRI>1 was the most significant predictor of advanced fibrosis(OR 3.85;95%CI:1.55–9.59).In patients without ultrasound-detected steatosis,20%had advanced fibrosis and 16.7%had active *** with suspected NAFLD should routinely be evaluated for advanced liver disease,including non-invasive indices of fibrosis such as APRI,and serious consideration given to liver biopsy.

关键词： cirrhosis non-alcoholic fatty liver disease non-alcoholic steatohepatitis aspartate aminotransferase-to-platelet ratio index