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Management of hepatitis C infection before and after liver transplantation

World Journal of Gastroenterology 2015年第15期21卷 4447-4456页

作者： Stefano Fagiuoli Roberto Ravasio Maria Grazia Lucà Anna Baldan silvia pecere Alessandro Vitale Luisa Pasulo Gastroenterology and Transplant Hepatology Papa Giovanni XXIII Hospital PHarm ES Milano Liver Transplantation and Hepatobiliary Surgical Unit Padua University Hospital

Chronic hepatitis C(CHC) is the most common indication for liver transplantation(LT). Aggressive treatment of hepatitis C virus(HCV) infection before cirrhosis development or decompensation may reduce LT need and risk of HCV recurrence post-LT. Factors associated with increased HCV risk or severity of recurrence include older age, immunosuppression, HCV genotype 1 and high viral load at LT. HCV recurrence post-LT leads to accelerated liver disease and cirrhosis development with reduced graft and patient survival. Currently, interferon(IFN)-based regimens can be used in dualagent regimens with ribavirin, in triple-agent antiviral strategies with direct-acting antivirals(e.g., protease inhibitors telaprevir or boceprevir), or before transplant in compensated patients to reduce HCV viral load to prevent or reduce the risk of post-LT recurrence and complications; they cannot be used in patients with decompensated cirrhosis. IFN-based regimens are used in less than half of HCV-infected patients waiting for LT due to extremely low efficacy and poor tolerability. However, antiviral therapy is indicated after LT in patients with histologically confirmed CHC despite tolerability issues. Improvements in side effect management have increased survival in patients achieving therapeutic targets. HCV treatment pre- and post-LT results in significant health care costs especially when lack of efficacy leads to disease worsening, although studies have shown sofosbuvir treatment before LT vs conventional post-LT dual antiviral is cost effective. The suboptimal efficacy and tolerability of IFN-based therapies, plus the significant economic burden, means the need for effective and well tolerated IFN-free antiHCV therapy for pre- and post-LT remains high.

关键词： Hepatitis C virus Orthotopic liver trans plantation Interferon-free treatment Decompensated cirrhosis Chronic hepatitis C

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Effect of rifaximin on gut microbiota composition in advanced liver disease and its complications

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World Journal of Gastroenterology 2015年第43期21卷 12322-12333页

作者： Francesca Romana Ponziani Viviana Gerardi silvia pecere Francesca D'Aversa Loris Lopetuso Maria Assunta Zocco Maurizio Pompili Internal Medicine and Gastroenterology Agostino Gemelli Hospital

Liver cirrhosis is a paradigm of intestinal dysbiosis. The qualitative and quantitative derangement of intestinal microbial community reported in cirrhotic patients seems to be strictly related with the impairment of liver function. A kind of gut microbial "fingerprint",characterized by the reduced ratio of "good" to "potentially pathogenic" bacteria has recently been outlined,and is associated with the increase in Model for End-Stage Liver Disease and Child Pugh scores. Moreover,in patients presenting with cirrhosis complications such as spontaneous bacterial peritonitis(SBP),hepatic encephalopathy(HE),and,portal hypertension intestinal microbiota modifications or the isolation of bacteria deriving from the gut are commonly reported. Rifaximin is a non-absorbable antibiotic used in the management of several gastrointestinal diseases. Beyond bactericidal/bacteriostatic,immune-modulating and anti-inflammatory activity,a little is known about its interaction with gut microbial environment. Rifaximin has been demonstrated to exert beneficial effects on cognitive function in patients with HE,and also to prevent the development of SBP,to reduce endotoxemia and to improve hemodynamics in cirrhotics. These results are linked to a shift in gut microbes functionality,triggering the production of favorable metabolites. The low incidence of drug-related adverse events due to the small amount of circulating drug makes rifaximin a relatively safe antibiotic for the modulation of gut microbiota in advanced liver disease.

关键词： Liver cirrhosis Gut microbiota Rifaximin Hepatic e

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Management of hepatitis C infection before and after livertransplantation

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World Journal of Gastroenterology 2015年第15期21卷 4457-4465页

作者： Fagiuoli Ravasio Lucà M Baldan pecere Vitale Pasulo Stefano Fagiuoli Maria Grazia Lucà Anna Baldan Silvia Pecere Luisa Pasulo Gastroenterology and Transplant Hepatology Papa Giovanni XXIII Hospital 24127 Bergamo Italy

Healthcare systems throughout the world continueto face emerging challenges associated with chronicdisease management. Due to the likely increase inchronic conditions in the future it is now vital thatcooperation and support between specialists, generalistsand primary health care physicians is *** bowel disease （IBD） is one such chronicdisease. Despite specialist care being essential, muchIBD care could and probably should be delivered inprimary care with continued collaboration betweenall stakeholders. Whilst most primary care physiciansonly have few patients currently affected by IBD intheir caseload, the proportion of patients with IBDrelatedhealthcare issues cared for in the primarycare setting appears to be widespread. Data suggestshowever, that primary care physician＇s IBD knowledgeand comfort in management is suboptimal. Currenttreatment guidelines for IBD are helpful but they arenot designed for the primary care setting. Few nonexpertIBD management tools or guidelines existcompared with those used for other chronic diseasessuch as asthma and scant data have been publishedregarding the usefulness of such tools including IBDaction plans and associated supportive literature. Thepurpose of this review is to investigate what nonspecialisttools, action plans or guidelines for IBD arepublished in readily searchable medical literature andcompare these to those which exist for other chronicconditions.

关键词： Inflammatory bowel disease Ulcerativecolitis Crohn's disease Guidelines Management tools

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