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103. Liver biopsy in the real world—reporting, expert concordance and correlation with a pragmatic clinical diagnosis.

Author

Kim, Hannah P., Idowu, Michael O., Mospan, Andrea R., Allmon, Andrew G., Roden, Michael, Newsome, Philip, Lok, Anna S., Thuluvath, Paul J., Taunk, Jawahar, Fried, Michael W., Sanyal, Arun J., Barritt, A. Sidney, Abdelmalek, Manal, Aguilar, Humberto, Ahmed, Aijaz, Allen, Alina, Barlow, Sarah, Barritt, Sid, Bernstein, David, and Bhamidimarri, Kaylan

Subjects
LIVER biopsy, DIAGNOSIS, NON-alcoholic fatty liver disease, FATTY liver, TYPE 2 diabetes
Abstract

Summary: Background: Patients with non‐alcoholic steatohepatitis (NASH) and fibrosis stage ≥2 comprise a target population for pharmacotherapy. Liver biopsy, the reference standard for identifying this population, requires complete and accurate assessment of steatohepatitis and fibrosis. Aims To investigate the completeness of real‐world NASH‐related pathology reports, assess concordance between site pathologists and central expert interpretation of the histologic elements of NASH, and determine concordance between biopsy‐diagnosed NASH and a pragmatic clinical definition of NASH. Methods: Liver pathology reports from 222 patients across 38 TARGET‐NASH sites were analysed for documentation of the histologic features of NASH. Biopsy slides were over‐read by a blinded central expert pathologist. Concordance of histologic scores and interpretation was assessed. Histologic concordance with a clinical definition of NASH was determined. TARGET‐NASH clinically defined NASH: elevated ALT, hepatic steatosis on biopsy or imaging and ≥1 of the following: BMI ≥30 kg/m2, type 2 diabetes mellitus and dyslipidaemia. Results: Documentation of steatosis, lobular inflammation, portal inflammation and ballooning were missing from 21%, 35%, 46% and 40% of reports, respectively. There was slight‐to‐fair concordance (weighted kappa 0.01‐0.35) between site and central pathologists for inflammatory features, and moderate concordance (weighted kappa 0.56‐0.57) for fibrosis staging. Clinical definition of NASH was 75%‐91% concordant (94%‐95% sensitive) with biopsy‐diagnosed NASH. Conclusions: There is substantial variability in reporting and grading NASH and fibrosis staging in clinical practice. This heterogeneity may adversely impact patient assessment and translation of practice guidelines into reality. The TARGET‐NASH pragmatic clinical definition may serve as a valuable tool to accurately identify NASH patients in clinical practice. [ABSTRACT FROM AUTHOR]

Published
2021
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112. Marijuana Consumption in Liver Transplant Recipients

Author

Serrano Rodriguez, Pablo, primary, Strassle, Paula Diane, additional, Barritt, Alfred Sidney, additional, Watkins, Randall, additional, Gerber, David A., additional, Hayashi, Paul Hideyo, additional, and Desai, Chirag Sureshchandra, additional

Published
2019
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114. Randomized Controlled Trial of a Leucine-Metformin-Sildenafil Combination (NS-0200) on Weight and Metabolic Parameters.

Author

Zemel, Michael B., Kolterman, Orville, Rinella, Mary, Vuppalanchi, Raj, Flores, Omar, Barritt, A. Sidney, Siddiqui, Mohammad, Chalasani, Naga, and Barritt, A Sidney 4th

Subjects
RANDOMIZED controlled trials, LEUCINE, SILDENAFIL, SIRTUINS, ENERGY metabolism, BODY weight, COMPARATIVE studies, HYPOGLYCEMIC agents, RESEARCH methodology, MEDICAL cooperation, OBESITY, RESEARCH, STATISTICAL sampling, EVALUATION research, METFORMIN, BLIND experiment, PHOSPHODIESTERASE inhibitors, PHARMACODYNAMICS
Abstract

Objective: Leucine was previously demonstrated to allosterically activate mammalian sirtuin 1 and synergize with other sirtuin 1/AMP-activated protein kinase/nitric oxide pathway activators to modulate energy metabolism. The objective of this study was to evaluate the effects of a triple combination of leucine, metformin, and sildenafil (NS-0200) on body weight and obesity comorbidities in a phase 2 randomized trial.Methods: A total of 91 subjects with obesity were randomized to placebo, low dose (1.1 g leucine/0.5 g metformin/0.5 mg sildenafil), or high dose (1.1 g leucine/0.5 g metformin/1.0 mg sildenafil) twice daily for 16 weeks. Seventy subjects completed the trial and met all a priori compliance criteria. Hypertensive (n = 35) and hypertriglyceridemic (n = 22) subcohorts were also analyzed.Results: NS-0200 dose-responsively reduced weight; high dose reduced weight by 2.4 and 5.0 kg in the full and high-triglyceride cohorts, respectively (P < 0.0001). High-dose NS-0200 treatment also decreased blood pressure (-5.5 mm Hg diastolic pressure; P = 0.011), with greater effects among hypertensive subjects. NS-0200 also significantly reduced triglycerides and hemoglobin A1c. Significant improvement in ≥ 2 comorbidities was exhibited by 54% of subjects in the high-dose arm versus 5% of placebo subjects (P = 0.0009). Treatment-emergent adverse events did not significantly differ among groups.Conclusions: These data support further study of NS-0200 as a therapy for obesity and associated comorbidities. [ABSTRACT FROM AUTHOR]

Published
2019
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115. Opioid Use Is More Common in Nonalcoholic Fatty Liver Disease Patients with Cirrhosis, Higher BMI, and Psychiatric Disease.

Author

Moon, Andrew M., Watkins, Stephanie E., Lok, Anna S., Firpi-Morell, Roberto J., Trinh, Huy Ngoc, Kupec, Justin T., Schoen, Cheryl, Neuschwander-Tetri, Brent A., and Barritt, A. Sidney

Subjects
NON-alcoholic fatty liver disease, FATTY liver, MENTAL illness, CIRRHOSIS of the liver, OPIOIDS, OPIOID abuse
Abstract

Background: Opioid use is a topic of growing concern among patients with nonalcoholic fatty liver disease (NAFLD). Given safety concerns of opioids, proactively identifying subgroups of patients with an increased probability of opioid use may encourage practitioners to recommend alternative therapies for pain, thus reducing the likelihood of opioid misuse. This work assessed the prevalence and patient characteristics associated with opioid use in a real-world cohort of patients with NAFLD. Methods: TARGET-NASH, an observational study of participants at 55 academic and community sites in the United States, includes patients with NAFLD defined by pragmatic case definitions. Opioid use was defined as any documented opioid prescriptions in the year prior to enrollment. The association between patient characteristics and the odds of opioid use were modeled with stepwise multivariable logistic regression and tree ensemble methods (Classification and regression tree/Boosted Tree). Results: The cohort included 3,474 adult patients with NAFLD including 18.0% with documented opioid use. Variables associated with opioid use included presence of cirrhosis (OR 1.51, 95% CI 1.16–1.98), BMI ≥32 kg/m2 (OR 1.29, 95% CI 1.05–1.59), depression (OR 1.87, 95% CI 1.50–2.33), and anxiety (OR 1.59, 95% CI 1.27–1.98). In the boosted tree analysis, history of back pain, depression, and fibromyalgia had the greatest relative importance in predicting opioid use. Conclusion: Prescription opioids were used in nearly 1 of 5 patients with NAFLD. Given the safety concerns of opioids in patients with NAFLD, alternative therapies including low-dose acetaminophen and nonpharmacologic treatments should be considered for these patients. [ABSTRACT FROM AUTHOR]

Published
2021
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117. Clinical Problem-Solving: We Blew It

Author

Barritt, A. Sidney, Gifford, Bonnie D., Garrett, Anne, Hofmann, Lawrence, Calabrese, Carlo, Frederick, Margaret, and Kreisberg, Robert.

Published
1995

119. Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation

Author

Bataller, Ramon, Cheong, Jaeyoun, Cabezas, Joaquin, Lucey, Michael R., Hayashi, Paul H., Ndugga, Nambi J., Arora, Sumant, Barritt, Alfred Sidney, and Galanko, Joseph A.

Abstract

Pre-transplant renal failure is commonly reported to be a poor prognostic indicator affecting survival after liver transplantation (LT). However, whether the impact of renal failure on patient outcome varies according to the etiology of the underlying liver disease is largely unknown.

Published
2017
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124. Su1524 - Sustained Elevation in Alkaline Phosphatase is Associated with Greater Disease Severity in Real World NAFLD

Author

DeLemos, Andrew S., primary, Barritt, A. Sidney, additional, Bhamidimarri, Kalyan R., additional, Landis, Charles, additional, Malahias, Laura, additional, Malespin, Miguel, additional, Schoen, Cheryl, additional, Taunk, Jawahar, additional, Thuluvath, Paul J., additional, Trinh, Huy N., additional, and Tetri, Brent, additional

Published
2018
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133. Characteristics of Adults in the Hepatitis B Research Network in North America Reflect Their Country of Origin and Hepatitis B Virus Genotype

Author

Hassan, Mohamed, MacGregor, Joan M., Luketic, Velimir A., Cooper, Stewart L., DeVole, Nata, Betts, Michael, Niu, Jianghe, Fontana, Robert J., Wong, David K., Khudyakov, Yury, Walters, Barbara, Chang, Kyong Mi, Punkova, Lili T., Cardona, Danielle, Lawlor, Sharon, Morris, Nevitt, Belle, Steven H., Zadorozny, Ella, Di Bisceglie, Adrian M., Mathisen, Terri, Minshall, Stacey, King, Debra L., Kleiner, David, Wahed, Abdus, Nagy, Rosemary A., Hofmann, Charlotte, Poerzgen, Peter, Haynes-Williams, Vanessa, Cardona-Gonzalez, Lupita, Haller, Tamara, Tran, Tram T., Cloonan, Yona, Chung, Raymond T., French, Samuel, Lisker-Melman, Mauricio, Peacock, Velma, Feld, Jordan, Danielson, Michelle, Stadheim, Linda, Barritt, A. Sidney, Olson, Emma, Do, Son, Terrault, Norah A., McKenna, Barbara, Juan, Joshua, Torrey, Keith, Smith, Paula G., Keith, James, Liu, Lucie, Perrillo, Robert, Park, Jang June, Kelley, Stephanie, Shuhart, Margaret C., Sterling, Richard K., Kowdley, Kris V., Yim, Colina, Montaner, Luis J., Carithers, Robert C., Kaza, Sravanthi, Oberhelman, Kelly, Tsai, Naoky, Pelesko, Andrew, Levine, Danielle, La, Danie, Javaid, Asad, Rodd, Cassandra, Lau, Daryl T.Y., Mooney, Jody, Janssen, Harry L.A., Lombardero, Manuel, Valiga, Mary E., Lok, Anna Suk Fong, Stoliker, Donna, Teo, Chong Gee, Heathcoate, Jenny, Li, Ruosha, Fried, Michael W., Roberts, Lewis R., Ungermann, Ashley, Lee, William M., Johnson, Geoffrey, Huddleston, Leslie, Strom, Susan, Metheny, Vikki, Lau, Ivy, Darling, Jama M., Han, Johanna, Ganova-Raeva, Lilia Milkova, Kim, W. Ray, Han, Steven Huy B., Nasser, Imad, Stahler, Alisha C., Smith, Coleman I., Afdhal, Nezam, Wang, Chia C., Khalili, Mandana, Patel, Keyur, Bass, Sheila, Ayala, Claudia, Marsh, Tiffany, Rivera, Elenita, Liang, T. Jake, Fryzek, Nancy, Ghany, Marc G., Podolskaya, Veronika, and Evon, Donna

Abstract

Chronic hepatitis B virus (HBV) infection is an important cause of cirrhosis and hepatocellular carcinoma worldwide; populations that migrate to the US and Canada might be disproportionately affected. The Hepatitis B Research Network (HBRN) is a cooperative network of investigators from the United States and Canada, created to facilitate clinical, therapeutic, and translational research in adults and children with hepatitis B. We describe the structure of the network and baseline characteristics of adults with hepatitis B enrolled in the network.

Published
2015
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134. Great time at San Elijo

Author

Barritt, A. Sidney

Abstract

We have enjoyed the "Hotspots Near You" section ever since it debuted but haven't had the chance until just recently to try out one of the suggestions. That came when […]

Published
2008

138. Declining liver utilization for transplantation in the United States and the impact of donation after cardiac death

Author

Barritt, A. Sidney, Wheeler, Stephanie B., Hayashi, Paul H., and Orman, Eric S.

Abstract

Worsening donor liver quality resulting in decreased organ utilization may be contributing to the recent decline in liver transplants nationally. We sought to examine trends in donor liver utilization and the relationship between donor characteristics and non-use. We used the United Network for Organ Sharing database to review all deceased adult organ donors in the United States who had at least one solid organ transplanted into a recipient. Trends in donor characteristics were examined. Multivariate logistic regression was used to evaluate the association between donor characteristics and liver non-use between 2004 and 2010. Population attributable risk proportions were determined for donor factors associated with non-use. 107,259 organ donors were analyzed. The number of unused livers decreased steadily from 1,958 (66% of donors) in 1988 to 841 (15%) in 2004, but then gradually increased to 1,345 (21%) in 2010. Donor age, body mass index (BMI), and the prevalence of diabetes and donation after cardiac death (DCD) all increased over time, and all four were independently associated with liver non-use. DCD had the highest adjusted odds ratio (OR) for non-use, and the odds increased nearly four-fold between 2004 (OR 5.53; 95% CI, 4.57–6.70) and 2010 (OR 21.31; 95% CI, 18.30–24.81). The proportion of non-use attributable to DCD increased from 9% in 2004 to 28% in 2010. The proportion of donor livers not used has increased since 2004. Older donor age, greater BMI, diabetes, and DCD are all independently associated with non-use and are on the rise nationally. Current trends may lead to significant declines in liver transplant availability.

Published
2013
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139. Increasing Prevalence of Hepatitis C among Hospitalized Children Is Associated with an Increase in Substance Abuse.

Author

IVBarritt, A. Sidney, Lee, Brian, Runge, Thomas, Schmidt, Monica, Jhaveri, Ravi, and Barritt, A Sidney 4th

Abstract

Objective: To evaluate the impact of substance abuse on pediatric hepatitis C virus (HCV) prevalence, we examined geographic and demographic data on inpatient hospitalizations in children with HCV.Study Design: We examined hospitalizations in children using the Kids' Inpatient Database, a part of the Healthcare Cost and Utilization Project. We identified cases using the International Classification of Diseases, 9th edition, codes for HCV infection during 2006, 2009, and 2012. Nonparametric tests for trend were used to calculate trend statistics.Results: From 2006 to 2012 nationally, the number of hospitalizations of children with HCV increased 37% (2.69 to 3.69 per 10 000 admissions; P < .001). The mean age of children hospitalized was 17.6 years (95% CI, 17.4-17.8). HCV cases among those 19-20 years of age represented 68% of the total HCV diagnoses, with a 54% increase over the years sampled (P < .001 for trend). The burden of HCV in children was highest in whites, those in the lowest income quartile, and in the Northeast and Southern regions of the US (all P < .0001). The prevalence of substance use among children with HCV increased from 25% in 2006 to 41% in 2012 (P < .001).Conclusion: The increases of HCV in hospitalized children are largely in teenagers, highly associated with substance abuse, and concentrated in Northeast and Southern states. These results strongly suggest that public health efforts to prevent and treat HCV will also need to include adolescents. [ABSTRACT FROM AUTHOR]

Published
2018
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141. Single Balloon Enteroscopy-Assisted ERCP for Treatment of Cholangitis in a Patient with a Kasai Portoenterostomy

Author

Grimm, Ian S., Orman, Eric S., Barritt, A. Sidney, and Miller, C. Brock

Subjects
Cholangiopancreatography, Endoscopic Retrograde, Young Adult, Postoperative Complications, Biliary Atresia, Cholangitis, Recurrence, Humans, Female, Portoenterostomy, Hepatic, Constriction, Pathologic, Article, Endoscopy, Gastrointestinal
Abstract

Primary therapy for biliary atresia is a surgical hepatoportoenterostomy (Kasai procedure), which has been shown to reduce mortality, but is frequently complicated by ascending cholangitis and the development of biliary cirrhosis. Previously reported therapy for recurrent cholangitis caused by biliary obstruction has included surgical revision and percutaneous biliary drainage, but endoscopic retrograde cholangiopancreatography has not been previously described. Here, we report a patient with recurrent cholangitis after a Kasai procedure and an anastomotic stricture successfully treated with single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. This novel technique could be considered in patients with this common complication of the Kasai procedure and may impact long-term outcomes in this patient population.

Published
2012

142. Characteristics of Adults in the Hepatitis B Research Network in North America Reflect Their Country of Origin and Hepatitis B Virus Genotype

Author

Ghany, Marc G., primary, Perrillo, Robert, additional, Li, Ruosha, additional, Belle, Steven H., additional, Janssen, Harry L.A., additional, Terrault, Norah A., additional, Shuhart, Margaret C., additional, Lau, Daryl T.-Y., additional, Kim, W. Ray, additional, Fried, Michael W., additional, Sterling, Richard K., additional, Di Bisceglie, Adrian M., additional, Han, Steven-Huy B., additional, Ganova-Raeva, Lilia Milkova, additional, Chang, Kyong-Mi, additional, Lok, Anna Suk-Fong, additional, Chung, Raymond T., additional, Roberts, Lewis R., additional, Smith, Coleman I., additional, Lisker-Melman, Mauricio, additional, Wong, David K., additional, Juan, Joshua, additional, Feld, Jordan, additional, Yim, Colina, additional, Heathcoate, Jenny, additional, Lee, William M., additional, Do, Son, additional, Tran, Tram T., additional, Khalili, Mandana, additional, Cooper, Stewart L., additional, Fontana, Robert J., additional, Tsai, Naoky, additional, Patel, Keyur, additional, Evon, Donna, additional, Carithers, Robert C., additional, Kowdley, Kris V., additional, Wang, Chia C., additional, Liang, T. Jake, additional, Park, Jang-June, additional, Wahed, Abdus, additional, Kleiner, David, additional, Afdhal, Nezam, additional, Javaid, Asad, additional, Niu, Jianghe, additional, Han, Johanna, additional, Nasser, Imad, additional, Stahler, Alisha C., additional, Stadheim, Linda, additional, Hassan, Mohamed, additional, King, Debra L., additional, Nagy, Rosemary A., additional, La, Danie, additional, Liu, Lucie, additional, Minshall, Stacey, additional, Bass, Sheila, additional, French, Samuel, additional, Peacock, Velma, additional, Ungermann, Ashley, additional, Ayala, Claudia, additional, Olson, Emma, additional, Lau, Ivy, additional, Podolskaya, Veronika, additional, DeVole, Nata, additional, McKenna, Barbara, additional, Oberhelman, Kelly, additional, Kaza, Sravanthi, additional, Rodd, Cassandra, additional, Huddleston, Leslie, additional, Poerzgen, Peter, additional, Darling, Jama M., additional, Barritt, A. Sidney, additional, Marsh, Tiffany, additional, Metheny, Vikki, additional, Cardona, Danielle, additional, Luketic, Velimir A., additional, Smith, Paula G., additional, Hofmann, Charlotte, additional, Mathisen, Terri, additional, Strom, Susan, additional, Mooney, Jody, additional, Cardona-Gonzalez, Lupita, additional, Fryzek, Nancy, additional, Rivera, Elenita, additional, Morris, Nevitt, additional, Haynes-Williams, Vanessa, additional, Valiga, Mary E., additional, Torrey, Keith, additional, Levine, Danielle, additional, Keith, James, additional, Betts, Michael, additional, Montaner, Luis J., additional, Teo, Chong-Gee, additional, Khudyakov, Yury, additional, Punkova, Lili T., additional, Cloonan, Yona, additional, Danielson, Michelle, additional, Haller, Tamara, additional, Johnson, Geoffrey, additional, Kelley, Stephanie, additional, Lawlor, Sharon, additional, Lombardero, Manuel, additional, MacGregor, Joan M., additional, Pelesko, Andrew, additional, Stoliker, Donna, additional, Walters, Barbara, additional, and Zadorozny, Ella, additional

Published
2015
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148. Reply

Author

Barritt, A. Sidney, primary, Orman, Eric S., additional, and Hayashi, Paul H., additional

Published
2012
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