Purpose of review We aim to evaluate the efficacy of risk-based surveillance strategies for hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) patients, addressing key questions: How can risk stratification enhance early detection? What are cost-effective approaches across diverse settings? How may novel diagnostic tools enhance surveillance? Recent findings Recent...
Purpose of Review Reviewing the current and future management options for patients with refractory ascites (RA) related to end-stage liver disease and resultant portal hypertension. Recent Findings RA can be curtailed with the creation of a TIPS (trans-jugular intrahepatic portosystemic) shunt in selective patients due to the risk of exacerbating hepatic encephalopathy (HE) and...
Purpose of Review This review focuses on the emerging roles of AFP-L3 and DCP as complementary biomarkers to AFP in the diagnosis, management, and surveillance of hepatocellular carcinoma (HCC). We aim to provide a comprehensive overview of their utility in improving HCC outcomes, including early detection, risk stratification, treatment response, and post-transplant monitoring...
This review provides a comprehensive overview of alcohol-associated liver disease (ALD), focusing on the spectrum of ALD, the utility of non-invasive diagnostic tests, and risk stratification for hepatocellular carcinoma (HCC) in ALD patients. Special attention is given to a newly recognized disease entity, metabolic dysfunction associated steatotic liver disease (MASLD) with...
We aim to provide a mechanistic review of available anti-emetic medications along with practical strategies of use and future areas of study in patients with cirrhosis. There is a dearth of liver-specific data for most, if not all, antiemetic medications in patients with cirrhosis. Of medications available, 5HT3 antagonists, prokinetics, and atypical antipsychotics carry targeted...
This narrative review aims to update current knowledge about frailty, sarcopenia, and their interplay, highlight gaps in the literature. Sarcopenia involves loss of skeletal muscle mass, while frailty reflects broader functional decline, including muscle strength impairment. These conditions are interrelated, but distinct and poor correlation between them has been reported...
This review aims to provide a summary of intensive care management and liver transplant (LT) considerations for critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). Survival rates for transplanted ACLF patients now approach those of non-ACLF LT recipients. However, candidate selection remains challenging, with high rates of waitlist removal and...
Despite refractory ascites (RA) due to cirrhosis having a median transplant-free survival of 6–12 months, palliative care (PC) input remains uncertain. We aimed to review the existing literature on clinical outcomes in cirrhosis-related RA and report the findings of a single-centre retrospective cohort study with a special focus on linkage to PC in this cohort of patients. Our...
Hepatocellular carcinoma (HCC) is the most common primary liver tumor and 6th most common cancer overall. This article reviews the role of laparoscopy in the multi-disciplinary management of HCC. Laparoscopic surgery involves multiple approaches for diagnosis and treatment of HCC, including intraoperative ultrasound and biopsy, as well as ablative strategies for tumors in...
The purpose of the article is to review treatment options for patients with AIH for whom first-line therapy is not successful. We outline recommended approaches for providers and new therapies on the horizon. Budesonide, while advantageous in some respects, may not be as effective as predniso(lo)ne. Mycophenolate mofetil is most effective in the setting of azathioprine...
Hepatitis B virus reactivation (HBVr) can complicate the use of immunosuppressive, antiviral, and chemotherapeutic medications in individuals with a history of prior exposure to HBV or chronic infection. Timely management is crucial to prevent fatalities. This review focuses on the various classes of biologics linked to the risk of HBVr, with emphasis on newer immunosuppressive...
Cholestatic pruritus refers to the sensation of itch experienced by patients with disease processes impairing bile flow. This article aims to illustrate the burden of cholestatic pruritus, review the proposed mechanisms, and summarize its available and emerging therapies. Pruritus is experienced by many patients with cholestatic liver diseases. It is underdiagnosed and negatively...
Liver transplantation remains the gold-standard treatment for cirrhotic patients with early stage, surgically unresectable hepatocellular carcinoma (HCC). In this review, we describe the current state of liver transplantation (LT) for HCC. We review recent advances in expanded indications for LT, diagnostics with liquid biopsy and biomarkers, and the emerging role of...
The World Health Assembly called to eliminate viral hepatitis as a public health threat in 2016 and proposed elimination goals by 2030. This review examined current national and global progress with hepatitis B virus elimination, and the hurdles and solutions being undertaken to achieve elimination goals. Few countries are on target to achieve the elimination targets of a 95...
This paper aims to investigate the crucial role of palliative care in the management of chronic liver disease (CLD) and cirrhosis. Faced with a global surge in liver-related morbidity and mortality, our goal is to understand the impact of early engagement with palliative care specialists on symptom management, quality of life, and the overall trajectory of advanced liver disease...
Advancements in our understanding of the hepatitis B viral (HBV) life cycle have paved the way for novel approaches to treat HBV infection. This review summarizes the various strategies being pursued to achieve a functional cure, defined as loss of hepatitis B surface antigen (HBsAg) and absence of viral replication 6 months off-therapy. Direct acting antiviral, host targeting...
Hepatitis D Virus (HDV), although a small defective virus, poses a substantial public health challenge due to lack of awareness, underrecognized prevalence, and limited treatment options. Universal HDV screening within hepatitis B virus (HBV) cohorts is essential to address this issue. Despite its aggressive nature, effective HDV therapies have remained elusive for over four...
Recombinant adeno-associated virus (rAAV) is the commonest viral vector used in gene therapies. With the increase in the number of such therapies being employed in human clinical trials and approved clinical use, the associated adverse events are increasingly observed. Hepatotoxicity is the most common adverse event. Although mild in most, hepatotoxicity may affect gene therapy...
Hepatitis B (HBV) remains a health threat around the world. Hepatitis C is closer to meeting the World Health Organization’s 2030 elimination goal compared to HBV. To achieve a successful micro-elimination and macro-elimination, there are certain objectives that need to be met. HBV infects more than 262 million people worldwide and is associated with significant morbidity and...
Clinically significant portal hypertension (CSPH) is a serious clinical condition causing decompensation and potentially fatal complications especially in the presence of advanced liver disease. This article aims to critically review the current literature on non-invasive assessment of CSPH. The Baveno VII consensus encouraged non-invasive assessment of CSPH to identify patients...
This review article will examine portal hypertension in alcoholic hepatitis (AH) from both a basic mechanistic and a clinical perspective. Alcoholic hepatitis is a major public health problem in the USA, accounting for over 300,000 hospital admissions in a recent year of data (Jinjuvadia et al. J Clin Gastroenterol. 60;49:506–511). Portal hypertension is a key consequence of AH...
Portal hypertension is responsible of the main complications of cirrhosis, which carries a high mortality. Recent treatments have improved prognosis, but this is still far from ideal. This paper reviews new potential therapeutic targets unveiled by advances of key pathophysiologic processes. Recent research highlighted the importance of suppressing etiologic factors and a safe...
Metabolic liver diseases encompass several different inherited conditions that affect metabolism and can lead to hepatic dysfunction. Understanding the role of dietary interventions is critical, as nutrition continues to play a large role in management of these diseases and at times can even be lifesaving. Despite novel genetic and enzymatic therapies, dietary management remains...
Our understanding of beta blockers in liver cirrhosis has transformed over the last 40 years. However, questions remain over their safety in acute decompensation and acute on chronic liver failure. Since these conditions are associated with significant morbidity and mortality, a critical appraisal of recent literature is imperative to help guide clinicians. The latest BAVENO...
The COVID-19 pandemic has resulted in over 800,000 deaths worldwide and resulted in fundamental changes in practice in nearly every aspect of medicine. The majority of symptomatic patients experience liver-associated enzyme (LAE) elevations which appear to be correlated to disease severity. Furthermore, there are unique considerations of COVID-19 on chronic liver disease...