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Individualized treatment options for patients with non-cirrhotic and cirrhotic liver disease

World Journal of Gastroenterology 2021年第19期27卷 2281-2298页

作者： Lukas Hartl Joshua Elias gerhard prager Thomas Reiberger Lukas W Unger Division of Gastroenterology and Hepatology Department of Internal Medicine IIIMedical University of ViennaVienna A-1090Austria Vienna Hepatic Hemodynamic Lab Medical University of ViennaVienna A-1090Austria Cambridge Institute of Therapeutic Immunology and Infectious Disease Jeffrey Cheah Biomedical CentreUniversity of CambridgeCambridge CB20AWUnited Kingdom Division of Gastroenterology and Hepatology Department of MedicineUniversity of CambridgeAddenbrooke’s HospitalCambridge CB20QQUnited Kingdom Division of Visceral Surgery Department of General SurgeryMedical University of ViennaVienna A-1090Austria

The obesity pandemic has led to a significant increase in patients with metabolic dysfunction-associated fatty liver disease(MAFLD).While dyslipidemia,type 2 diabetes mellitus and cardiovascular diseases guide treatment in patients without signs of liver fibrosis,liver related morbidity and mortality becomes relevant for MAFLD’s progressive form,non-alcoholic steatohepatitis(NASH),and upon development of liver *** should be prescribed in patients without significant fibrosis despite concomitant liver diseases but are underutilized in the real-world *** surgery,especially Y-Roux bypass,has been proven to be superior to conservative and/or medical treatment for weight loss and resolution of obesity-associated diseases,but comes at a low but existent risk of surgical complications,reoperations and very rarely,paradoxical progression of *** end-stage liver disease develops,obese patients benefit from liver transplantation(LT),but may be at increased risk of perioperative infectious *** LT,metabolic comorbidities are commonly observed,irrespective of the underlying liver disease,but MAFLD/NASH patients are at even higher risk of disease *** studies with low patient numbers evaluated if,and when,bariatric surgery may be an option to avoid disease recurrence but more high-quality studies are needed to establish clear *** this review,we summarize the most recent literature on treatment options for MAFLD and NASH and highlight important considerations to tailor therapy to individual patient’s needs in light of their risk profile.

关键词： Metabolic dysfunction-associated fatty liver disease Non-alcoholic fatty liver disease Portal hypertension Cirrhosis Bariatric surgery Metabolism

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Accuracy of non-invasive liver stiffness measurement and steatosis quantification in patients with severe and morbid obesity

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Hepatobiliary Surgery and Nutrition 2021年第5期10卷 610-622,I0004-I0007页

作者： Magdalena Eilenberg Petra Munda Judith Stift Felix BLanger gerhard prager Michael Trauner Katharina Staufer Division of General Surgery Department of SurgeryMedical University of ViennaViennaAustria Department of Visceral Surgery and Medicine InselspitalUniversity Hospital BernBernSwitzerland Division of Gastroenterology&Hepatology Department of Internal Medicine IIIMedical University of ViennaViennaAustria Clinical Institute of Pathology Medical University of ViennaViennaAustria Division of Transplantation Department of SurgeryMedical University of ViennaViennaAustria

Background:Vibration controlled transient elastography(VCTE)and controlled attenuation parameter(CAP™)have shown reliable performance predicting fibrosis and steatosis in normal-to overweight patients but have not been validated in severe to morbid *** study aimed at determining the accuracy of VCTE,CAP™and the composite score FibroScan-AST(FAST)in patients with a body mass index(BMI)of≥35 kg/m^(2).Methods:Patients scheduled for bariatric-metabolic surgery underwent preoperative VCTE/CAP™measurement,and intraoperative liver *** feasibility and accuracy of VCTE,CAP™and the composite score FAST were retrospectively analysed to evaluate fibrosis,steatosis and active fibrotic non-alcoholic steatohepatitis[NASH+non-alcoholic fatty liver disease(NAFLD)activity score≥4+fibrosis grade≥2]using per protocol(PP)and intent to diagnose(ITD)***:In total,170 patients(median BMI 44.4 kg/m²)were included in the *** biopsy showed NASH,simple steatosis,and normal livers in 60.6%(n=103),28.8%(n=49),and 10.6%(n=18),*** and CAP™delivered reliable results in 90.6%(n=154/170)and 90.5%(n=134/148).The AUC(PP)of VCTE,CAP™,and FAST were 0.687(≥F2),0.786(≥F3),0.703(≥S2),0.738(S3),and 0.780(active fibrotic NASH).The AUC increased to 0.742(≥F2),0.842(≥F3),0.712(≥S2),0.780(S3),and 0.836(active fibrotic NASH)in patients below the median BMI of 44.4 kg/m².Conclusions:VCTE,CAP™and FAST show acceptable accuracy for the detection of fibrosis,steatosis and NASH in a real-life cohort of patients with *** improves in patients with a BMI<44.4 kg/m^(2).

关键词： Transient elastography controlled attenuation parameter(CAP™) FibroScan-AST score(FAST score) obesity non-alcoholic fatty liver disease(NAFLD)

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