23 results on '"Bouzbib C"'
Search Results
2. L’encéphalopathie hépatique, du diagnostic au traitement en 2016
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Mouri, S., Bouzbib, C., El Mourabit, H., Schaefer, A., Imbert-Bismut, F., Galanaud, D., Tripon, S., Mallet, M., Rudler, M., Housset, C., Thabut, D., and Weiss, N.
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- 2016
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3. Other causes of neurocognitive impairment than covert hepatic encephalopathy (CHE) are very frequent, either alone or associated with CHE, in cirrhotic patients with cognitive complaints.
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Sultanik P, Kheloufi L, Leproux A, Bouzbib C, Mouri S, Santiago A, Galanaud D, Navarro V, Sakka M, Rudler M, Weiss N, and Thabut D
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- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Electroencephalography, Magnetic Resonance Imaging, Adult, Prevalence, Hepatic Encephalopathy psychology, Liver Cirrhosis complications, Neuropsychological Tests, Cognitive Dysfunction etiology
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Background/aims: Although it is well admitted that cirrhotic patients display various causes of neurocognitive impairment (NI) hampering the diagnosis of covert hepatic encephalopathy (CHE), those are almost never investigated per se. The aims of this study were, in cirrhotic patients displaying cognitive complaints explored by a complete multimodal work-up, to assess: (1) the prevalence of CHE and/or that of other causes of NI and (2) their outcomes, according to the cause of NI., Methods: Prospective cohort of cirrhotic patients referred in a dedicated clinic because of cognitive complaints. Work-up included a complete neuropsychological assessment, electroencephalogram (EEG) and brain magnetic resonance imaging with spectroscopy. The diagnosis of CHE was made by an adjudication committee involving the physicians/neuropsychologist., Results: One hundred and twenty-three patients were included (alcohol/MASLD/virus in 63/53/14%, MELD = 11). Sixty-six per cent of them were diagnosed with CHE; among them, 73% exhibited also other causes of NI, mainly cerebrovascular diseases/psychiatric. Among patients without CHE, 48% and 59% displayed pathological Psychometric Hepatic Encephalopathy Score and animal naming test, respectively. Clinical improvement was observed in 77% of the patients re-evaluated after specific management. CHE, but not the other causes of NI, was independently associated with OHE occurrence., Conclusion: Other causes of NI than CHE are frequent in patients with cirrhosis, and not ruled-out by the classical tests dedicated to CHE. Prognosis was influenced by the cause of NI. The management of patients even without CHE led to clinical improvement, underlining the need for a multifaceted approach of cirrhotic patients with cognitive complaints., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)
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- 2024
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4. Prevalence and prognosis of patients with MASLD-related cirrhosis after an ICU hospitalization in France: A single-centre prospective study.
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Sultanik P, Lherault G, Bouzbib C, Ratziu V, Pais R, Mouri S, Thabut D, and Rudler M
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- Humans, Male, Female, Middle Aged, Prospective Studies, France epidemiology, Prevalence, Aged, Prognosis, Fatty Liver epidemiology, Fatty Liver complications, Adult, Liver Cirrhosis complications, Liver Cirrhosis mortality, Liver Cirrhosis epidemiology, Intensive Care Units statistics & numerical data, Hospitalization statistics & numerical data
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Background and Aims: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD)-related cirrhosis has been increasing these last decades. There are no data regarding the prevalence of MASLD-related cirrhosis in intensive care unit (ICU)., Methods: Prospective single-centre study in a cohort of patients hospitalized in the ICU of Hepatology La Pitié-Salpêtrière Hospital between January 2019 and September 2021. We analysed three groups of patients: MASLD-cirrhosis (alcohol ≤210 g for men and 140 g weekly for women), ALD (alcohol-related liver disease, alcohol>140 g weekly for women or >210 g for men)-cirrhosis alone and MetALD (metabolic and alcohol-related liver disease)-cirrhosis. Endpoints were 1-year transplant-free survival (TFS), further acute decompensation (AD) and re-admission., Results: A total of 410 patients were hospitalized, and 315 analysed: 39 in MASLD, 160 in ALD and 116 in MetALD groups. The global prevalence was 10% for MASLD, 41% ALD and 29.7% for MetALD. Patients in the MASLD group were significantly older (65 vs. 57 and 59 years, p < 0.001), and had lower Child-Pugh (8 vs. 11 vs. 10, p < 0.001) and MELD score (17 vs. 22 vs. 21, p < 0.001). The 1-year TFS was not different between groups (53% vs. 54% vs. 54%, p = 0.96). Cardiovascular mortality was <5% in all groups. The 1-year probability of developing hepatic encephalopathy was significantly higher in the MASLD group (73% vs. 27% and 21%, p < 0.001). There was no difference regarding the development of other complications between groups., Conclusion: MASLD or MetALD was responsible for 1/3 of the causes of cirrhosis in the ICU. MASLD-related cirrhosis is as severe as ALD-related cirrhosis. Liver transplantation should be rapidly discussed., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)
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- 2024
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5. To the Editor: Don't forget to discuss TIPS in patients surviving an episode of alcoholic hepatitis.
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Rudler M, Bouzbib C, and Thabut D
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- 2024
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6. MetALD accounts for a large part of what we call MASLD!
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Rudler M, Bouzbib C, and Thabut D
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- 2024
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7. Herpes Simplex Virus Hepatitis in Patients Requiring Intensive Care Unit Admission: A Retrospective, Multicenter, Observational Study.
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Frapard T, Amaddeo G, Decavele M, Abback PS, Gaillet A, Bouzbib C, Vanlemmens C, Younan R, Canet E, Moreau AS, Neuville M, Azoulay E, Sitbon A, Mokart D, Radenne S, Abergel A, Guichon C, Roux O, Bonadona A, Mekontso Dessap A, De Jong A, Dumortier J, and de Prost N
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The clinical features and short-term prognosis of patients admitted to the intensive care unit for herpes hepatitis are lacking. Of 33 patients admitted between 2006 and 2022, 22 were immunocompromised, 4 were pregnant women, and 23 died. Sixteen patients developed a hemophagocytic syndrome. Acyclovir was initiated a median (interquartile range) of 1 (0-3) day after admission., Competing Interests: Potential conflicts of interest. All authors: no reported conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2023
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8. Diagnosis and management of hepatic encephalopathy: The French recommendations.
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Thabut D, Bouzbib C, Meunier L, Haas M, Weiss N, Louvet A, Imbert-Bismut F, Mochel F, Nadjar Y, Santiago A, Thevenot T, Duhalde V, Oberti F, Francoz C, Coilly A, Hilleret MN, Lebray P, Liou-Schischmanoff A, Barbier L, Duvoux C, Pageaux GP, Bismuth M, Galanaud D, Broucker T, Cadranel JF, Leroy V, Di Martino V, Larrey D, Camus C, Scatton O, De Ledinghen V, Mallat A, Rudler M, and Bureau C
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- Humans, Liver Cirrhosis complications, Liver Cirrhosis therapy, Risk Factors, Prognosis, Treatment Outcome, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy etiology, Hepatic Encephalopathy therapy, Portasystemic Shunt, Transjugular Intrahepatic adverse effects
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Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease with poor patient outcomes. However, it is a poorly understood complication, with no consensus for diagnosis. Therefore, HE is often underdiagnosed. Differential diagnosis may be cumbersome because of non-specific symptoms, such as confusion, cognitive disorders, the aetiological factors of cirrhosis and comorbidities, which are often observed in cirrhotic patients. Therefore, an overt or covert form of HE should be systematically investigated. Advice is provided to drive patient work-up. Effective treatments are available to prevent or treat HE bouts, but the issue of single or combination therapy has not been resolved. Transjugular intrahepatic portosystemic shunt (TIPS) placement largely improved the prognosis of cirrhotic patients, but HE occurrence of HE is often a fear, even when post-TIPS HE can be avoided by a careful selection of patients and preventive treatment. HE is an indication of liver transplantation. However, its reversibility post-transplantation and the consequences of transplantation in patients with other causes of neurological disorders remain controversial, which supports the performance of an extensive work-up in expert centres for this subset of patients. The present guidelines assist clinicians in the diagnosis of the overt or covert form of HE to implement curative and preventive treatments and clarify which patients require referral to expert centres for consideration for liver transplantation. These guidelines are very clinically oriented and address different frequent clinical issues to help physicians make bedside decisions., (© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.)
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- 2023
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9. Blood ammonia in patients with chronic liver diseases: A better defined role in clinical practice.
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Mallet M, Desplats V, Bouzbib C, Sultanik P, Alioua I, Rudler M, Weiss N, and Thabut D
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- Brain, Diagnosis, Differential, Humans, Liver Cirrhosis, Ammonia, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy etiology
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Ammonia is one of the main players in the pathogenesis of hepatic encephalopathy (HE) in patients with chronic liver diseases. The usefulness of measuring ammonemia has been debated since many years. New data reveal that besides helping in the differential diagnosis of HE, ammonemia could be a prognostic marker not only in patients with HE, but also in patients without any neurological symptoms, suggesting a potential toxic role of ammonia beyond the brain. Finally, targeting ammonemia while monitoring therapeutic response could be a way to improve outcomes in patients with HE., Competing Interests: Declaration of competing interest Dominique Thabut declares having received consultant fees from MedDay Pharmaceuticals, Gore, Alfasigma and Owkin. Nicolas Weiss declares having received consultant fees from MedDay Pharmaceuticals and Owkin., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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10. ATP-binding cassette transporters expression in rats with cirrhosis and hepatic encephalopathy.
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Bouzbib C, El Mourabit H, Wendum D, Lasnier E, Mouri S, Housset C, Thabut D, Weiss N, and Rudler M
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- Animals, Rats, ATP Binding Cassette Transporter, Subfamily G, Member 2, Liver Cirrhosis complications, Multidrug Resistance-Associated Proteins genetics, Neoplasm Proteins, ATP-Binding Cassette Transporters genetics, ATP-Binding Cassette Transporters metabolism, Hepatic Encephalopathy etiology
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Background: Pathophysiology of acute encephalopathy in cirrhotic patients is not completely understood. Factors implicated include ammonia, inflammation, various metabolic disorders and drug toxicity. Recent studies have evidenced an increased permeability of the blood-brain barrier (BBB) in models of chronic liver disease and encephalopathy, either to solutes, or to leukocytes. A modification of the expression of BBB ATP-Binding Cassette (ABC) transporters, actively transporting endogenous and exogenous components through the BBB, has been described in models of acute liver failure. We hypothesized that a modification of ABC transporters expression may contribute to drug-induced acute encephalopathy in cirrhosis., Materiel and Methods: A rat model of cirrhosis induced by Bile Duct Ligation (BDL) was studied, and compared to a SHAM rat model. Rats were sacrificed and brains studied after decapitation. Genic expression of ABC transporters, including P-gp, BCRP, MRP1, MRP2, MRP4 and MRP5 was evaluated by RT-qPCR on isolated brain microvessels. Encephalopathy was assessed 6 weeks after surgery by a trail suspension test and an Open Field Test., Results: BDL rats developed a histologically proven cirrhosis and displayed a higher ammonemia than SHAM rats (183 µmol/L vs 53 µmol/L, p = 0.0003). BDL rats presented with encephalopathy shown by neurobehavioral tests. MRP2 was not detected neither in BDL nor in SHAM rats. There was a decrease in the genic expression of MRP5 6 weeks after surgery. Expressions of P-gp, BCRP, MRP1 and MRP4 were not different between the 2 groups., Conclusion: We suggest that acute encephalopathy in cirrhotic BDL rats may be associated to a modification of ABC transporter MRP5 on the BBB, that could be responsible for a decrease clearance of neurotoxic agents., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Masson SAS.)
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- 2022
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11. Non-invasive diagnosis and follow-up of portal hypertension.
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Thabut D, Weil D, Bouzbib C, Rudler M, Cassinotto C, Castéra L, Serste T, Oberti F, Ganne-Carrié N, de Lédinghen V, Bourlière M, and Bureau C
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- Endoscopy, Gastrointestinal, Follow-Up Studies, Humans, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Elasticity Imaging Techniques methods, Esophageal and Gastric Varices complications, Hypertension, Portal complications, Hypertension, Portal diagnosis
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Compensated advanced chronic liver disease (cACLD) describes the spectrum of advanced fibrosis/cirrhosis in asymptomatic patients at risk of developing clinically significant portal hypertension (CSPH, defined by a hepatic venous pressure gradient (HVPG) ≥10 mmHg). Patients with cACLD are at high risk of liver-related morbidity and mortality. In patients at risk of chronic liver disease, cACLD is strongly suggested by a liver stiffness (LSM) value >15 kPa or clinical/biological/radiological signs of portal hypertension, and ruled out by LSM <10 kPa, or Fibrotest® ≤0.58, or Fibrometer® ≤0.786. Patients with chronic liver disease (excluding vascular diseases) with a LSM <10 kPa are at low risk of developing portal hypertension complications. The presence of CSPH can be strongly suspected when LSM is ≥20 kPa. In a patient without clinical, endoscopic or radiological features of portal hypertension, measurement of the HVPG is recommended before major liver or intra-abdominal surgery, before extra-hepatic transplantation and in patients with unexplained ascites. Endoscopic screening for oesophageal varices can be avoided in patients with LSM <20 kPa and a platelet count >150 G/L (favourable Baveno VI criteria) at the time of diagnosis. There is no non-invasive method alternative for oeso-gastroduodenal endoscopy in patients with unfavourable Baveno criteria (liver stiffness ≥20 kPa or platelet count ≤50 G/l). Platelet count and liver stiffness measurements must be performed once a year in patients with cACLD with favourable Baveno VI criteria at the time of diagnosis. A screening oeso-gastroduodenal endoscopy is recommended if Baveno VI criteria become unfavourable., (Copyright © 2021. Published by Elsevier Masson SAS.)
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- 2022
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12. Non-invasive diagnosis and follow-up of autoimmune hepatitis.
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Lemoinne S, Heurgue A, Bouzbib C, Hanslik B, Gournay J, Nguyen-Khac E, Bureau C, de Lédinghen V, Ganne-Carrié N, and Bourlière M
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- Follow-Up Studies, Humans, Cholangitis, Sclerosing diagnosis, Cholangitis, Sclerosing therapy, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune drug therapy, Liver Cirrhosis, Biliary
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Autoimmune hepatitis (AIH) is a liver disease characterised by necrotico-inflammatory lesions of hepatocytes, the presence of specific autoantibodies and response to corticosteroid treatment. AIH must be considered in any patient with acute or chronic liver disease. As there is no pathognomonic sign of AIH, the diagnosis is based on a combination of clinical, biological, immunological and histological findings, after excluding other causes of liver disease. The clinical and biological presentation of AIH is variable and AIH can be associated with an autoimmune biliary disease, primary biliary cholangitis or primary sclerosing cholangitis in an overlap syndrome. For these reasons, diagnosis of AIH can be challenging. Even if liver histology remains essential in the diagnosis of AIH, non-invasive tests can be used at different steps of the management of AIH: diagnosis of AIH, notably diagnosis of an overlap syndrome, assessment of severity of AIH, searching for extra-hepatic disease frequently associated to AIH, evaluation of response to therapy, decision of treatment withdrawal. This review aims to provide practical guidelines for the use of non-invasive tests for the diagnosis and the follow-up of AIH., (Copyright © 2021. Published by Elsevier Masson SAS.)
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- 2022
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13. Non-invasive diagnosis and follow-up of primary sclerosing cholangitis.
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Chazouillères O, Potier P, Bouzbib C, Hanslik B, Heurgue A, NGuyen-Khac E, Gournay J, Tanne F, Bureau C, Bourlière M, Ganne-Carrié N, and de Lédinghen V
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- Bile Ducts, Intrahepatic pathology, Cholangiopancreatography, Endoscopic Retrograde methods, Follow-Up Studies, Humans, Bile Duct Neoplasms complications, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing diagnosis, Cholangitis, Sclerosing pathology, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases diagnosis
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Primary sclerosing cholangitis (PSC) is a rare and chronic cholestatic liver disease of unknown cause commonly associated with inflammatory bowel disease (IBD) and characterized by progressive obliterative fibro-inflammation of the biliary tree. Although the natural course is highly variable, PSC is often progressive, leading to biliary cirrhosis and its complications. In addition, PSC is a condition harbouring broad neoplastic potential with increased susceptibility for the development of both biliary and colon cancer. As in other chronic liver diseases, non-invasive methods play a major role in the diagnosis and monitoring of PSC. MR cholangiography is the key exam for the diagnosis and has replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP). A strict and standardised protocol for carrying out MR cholangiography is recommended. Liver stiffness measured by FibroScan® correlates with the degree of liver fibrosis, has a prognostic value and should be repeated during follow-up. Invasive methods still play an important role, especially ERCP which is indicated for therapeutic purposes or for endo-biliary sample collection in suspected cholangiocarcinoma (following discussion in a multidisciplinary team meeting) and total colonoscopy which is recommended at the initial diagnosis of any PSC and annually in patients with IBD., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2022
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14. Non-invasive diagnosis and follow-up of rare genetic liver diseases.
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Sobesky R, Guillaud O, Bouzbib C, Sogni P, Poujois A, Woimant F, Duclos-Vallée JC, Bourlière M, de Lédinghen V, Ganne-Carrié N, and Bureau C
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- Biomarkers, Copper, Follow-Up Studies, Humans, Liver, Rare Diseases, Hepatolenticular Degeneration diagnosis, Hepatolenticular Degeneration genetics, alpha 1-Antitrypsin Deficiency complications, alpha 1-Antitrypsin Deficiency diagnosis, alpha 1-Antitrypsin Deficiency genetics
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Rare genetic liver diseases can result in multi-systemic damage, which may compromise the patient's prognosis. Wilson's disease and alpha-1 antitrypsin deficiency must be investigated in any patient with unexplained liver disease. Cystic fibrosis screening of new-borns is now implemented in most high-prevalence countries. The diagnosis of these diseases can be strongly suggested with specific non-invasive tests. Molecular analysis gene for these diseases is long and tedious but is recommended to confirm the diagnosis and help for the family screening. Liver biopsy is not systematic and is discussed when it helps diagnosis. Currently, for these three diseases, non-invasive fibrosis markers could identify patients with risk of cirrhosis and complications. Rare genetic liver diseases can result in multi-systemic damage, which may compromise the patient's prognosis. Wilson's disease, must be investigated in any patient with unexplained liver disease and/or unexplained neurological or neuropsychiatric disorders. The diagnosis is based on a combination of clinical, biological features, including copper balance. The exchangeable copper/total copper ratio is a new sensible and specific biological marker, useful for the diagnosis of the disease. Timely diagnosis and treatment will prevent serious complications from the disease. Neurological evaluation and familial screening are essential in patients with Wilson's disease., Competing Interests: Declaration of Competing Interest BOURLIÈRE Marc: Abbott, BMS, Boehringer Ingelheim, Gilead, GSK, Idenix, Intercept, Janssen, Merck, Novartis, Roche, Vertex BOUZBIB Charlotte: AbbVie, Gilead, Novartis BUREAU Christophe AbbVie, Gilead, Gore DE LÉDINGHEN Victor: AbbVie, Alfasigma, BMS, Diafir, Echosens, Gilead, Indivior, Intercept, Medac, Myr Pharma, Pfizer, Promethera, Spimaco, Supersonic Imagine DUCLOS-VALLÉE Jean-Charles: No conflict of interest GANNE-CARRIÉ Nathalie: Bayer, Gilead, Ipsen, Roche, Shionogi GUILLAUD Olivier: Declared no conflicts of interest POUJOIS Aurélia: Declared no conflicts of interest SOBESKY Rodolphe: Declared no conflicts of interest SOGNI Philippe: AbbVie, BMS, Galmed, Genfit, Gilead, Intercept, Janssen, MSD, Viking WOIMANT France: Declared no conflicts of interest, (Copyright © 2021. Published by Elsevier Masson SAS.)
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- 2022
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15. Non-invasive diagnosis and follow-up of non-alcoholic fatty liver disease.
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Boursier J, Guillaume M, Bouzbib C, Lannes A, Pais R, Smatti S, Cariou B, Bureau C, Ganne-Carrié N, Bourlière M, and de Lédinghen V
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- Follow-Up Studies, Humans, Liver pathology, Liver Cirrhosis diagnosis, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease epidemiology
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NAFLD is a frequent disease that affects 25% of the worldwide population. There is no specific diagnostic test for NAFLD, and the diagnosis mainly relies on the elimination of the other causes of chronic liver diseases with liver biopsy kept for unsure diagnoses. Non-invasive tests are now available to assess NAFLD severity and therefore to help physicians decide on the patient management and follow-up. These non-invasive tests can also be used to define pathways that organize referrals from primary care and diabetology clinics to the liver specialist, with the ambition to improve the screening of asymptomatic patients with NAFLD and advanced liver disease. NAFLD being the liver expression of the metabolic syndrome, physicians need also take care to screen for diabetes and to evaluate the cardiovascular risk in those patients. These recommendations from the French Association for the Study of the Liver (AFEF) aim at providing guidance on the following questions: how to diagnose NAFLD; how non-invasive tests should be used to assess NAFLD severity; how to follow patients with NAFLD; when to perform liver biopsy in NAFLD; and how to decide referral to the liver specialist for a patient with NAFLD., Competing Interests: Declarations of Competing Interest BOURLIÈRE Marc: Abbott, BMS, Boehringer Ingelheim, Gilead, GSK, Idenix, Intercept, Janssen, Merck, Novartis, Roche, Vertex BOURSIER Jérôme: AbbVie, BMS, Echosens, Gilead, Intercept, Inventiva, Siemens Healthineers BOUZBIB Charlotte: AbbVie, Gilead, Novartis BUREAU Christophe: AbbVie, Gilead, Gore CARIOU Bertrand: Declared no conflicts of interest GANNE-CARRIÉ Nathalie: Bayer, Gilead, Ipsen, Roche, Shionogi GUILLAUME Maeva: AbbVie, Gilead, Novartis DE LÉDINGHEN Victor: AbbVie, Alfasigma, BMS, Diafir, Echosens, Gilead, Indivior, Intercept, Medac, Myr Pharma, Pfizer, Promethera, Spimaco, Supersonic Imagine LANNES Adrien: No conflict of interest PAIS Raluca: Intercept SMATTI Sarra: No conflict of interest, (Copyright © 2021. Published by Elsevier Masson SAS.)
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- 2022
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16. Prognosis of patients undergoing salvage TIPS is still poor in the preemptive TIPS era.
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Bouzbib C, Cluzel P, Sultanik P, Bernard-Chabert B, Massard J, Benosman H, Mallet M, Tripon S, Conti F, Thabut D, and Rudler M
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- Female, Gastrointestinal Hemorrhage epidemiology, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Treatment Outcome, Esophageal and Gastric Varices surgery, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Salvage Therapy
- Abstract
Background: Salvage transjugular intrahepatic portosystemic shunts (TIPS) are associated with poor prognosis, especially in patients with Child-Pugh C cirrhosis. Since preemptive TIPS improved prophylaxis of variceal bleeding in those patients, recourse to salvage TIPS may now affect patients with a better prognosis., Aim: To assess the impact of the preemptive TIPS policy on outcomes after salvage TIPS placement., Methods: We conducted a retrospective monocentric study on cirrhotic patients undergoing salvage TIPS with polytetrafluoroethylene-covered stents from 2002 to 2017 (period 1 until February 2011; period 2 after the preemptive TIPS policy in March 2011). The primary endpoint was one-year transplant-free survival., Results: We included 106 patients (period 1/2 = 53/53 patients, male gender 82%, age 54 ± 9 years, alcoholic cirrhosis 70%, Child-Pugh score B/C 94%). One-year transplant-free survival was 46.0% during period 1 compared to 40.2% during period 2 (p = 0.65). Amongst 61 patients with history of variceal bleeding, 32 (52.5%) had an inadequate secondary prophylaxis, including 19 (59.4%) with a previous indication of preemptive TIPS. One-year transplant-free survival was 33.2% if inadequate secondary prophylaxis vs 65.2% if adequate (p = 0.008). Independent factors associated with survival were a lower Child-Pugh or MELD score, infection, failure to control bleeding, and hepatic encephalopathy after TIPS., Conclusion: Prognosis after salvage TIPS remained poor in our series. Optimizing secondary prophylaxis, including preemptive TIPS placement, should be the main concern to improve prognosis., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
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- 2021
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17. Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding.
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Walter A, Rudler M, Olivas P, Moga L, Trépo E, Robic MA, Ollivier-Hourmand I, Baiges A, Sutter O, Bouzbib C, Peron JM, Le Pennec V, Ganne-Carrié N, Garcia-Pagán JC, Mallet M, Larrue H, Dao T, Thabut D, Hernández-Gea V, Nault JC, Bureau C, and Allaire M
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- Biomarkers blood, End Stage Liver Disease diagnosis, Female, France epidemiology, Humans, Liver Cirrhosis mortality, Male, Middle Aged, Organ Dysfunction Scores, Predictive Value of Tests, Prognosis, Salvage Therapy methods, Spain epidemiology, Survival Analysis, Esophageal and Gastric Varices etiology, Esophageal and Gastric Varices surgery, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage physiopathology, Gastrointestinal Hemorrhage surgery, Hypertension, Portal etiology, Hypertension, Portal physiopathology, Hypertension, Portal surgery, Lactic Acid blood, Liver Cirrhosis complications, Portasystemic Shunt, Transjugular Intrahepatic adverse effects, Portasystemic Shunt, Transjugular Intrahepatic methods, Portasystemic Shunt, Transjugular Intrahepatic mortality
- Abstract
Background and Aims: Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients., Approach and Results: One hundred sixty-four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann-Whitney and Fischer's exact test. Six-week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan-Meier curves with log-rank test and univariate/multivariate analyses using the Cox model. Eighty-three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol-associated cirrhosis, 88%; Model for End-Stage Liver Disease [MELD], 19 [15-27]; arterial lactate, 3.7 mmol/L [2.0-8.3]). Six-week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005-1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013-1.114; P = 0.032) were associated with 6-week OS. Six-week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6-week OS was 67%. Six-week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute-on-chronic liver failure grade (OR, 1.699; 95% CI, 1.056-1.663; P = 0.040) was independently associated with rebleeding., Conclusions: After salvage TIPS, 6-week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was >85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was >90% for lactate ≥12 mmol/L and/or MELD score ≥ 30., (© 2021 by the American Association for the Study of Liver Diseases.)
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- 2021
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18. Diagnosis and Management of Hepatic Encephalopathy.
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Rudler M, Weiss N, Bouzbib C, and Thabut D
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- Humans, Incidence, Liver Cirrhosis complications, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy epidemiology, Hepatic Encephalopathy etiology, Hypertension, Portal diagnosis, Hypertension, Portal therapy, Portasystemic Shunt, Transjugular Intrahepatic
- Abstract
Hepatic encephalopathy (HE) is a severe complication of cirrhosis. The prevalence of overt HE (OHE) ranges from 30% to 45%, whereas the prevalence of minimal HE (MHE) is as high as 85% in some case series. Widespread use of transjugular intrahepatic portosystemic shunt to control complications related to portal hypertension is associated with an increase in HE incidence. If the diagnosis of OHE remains simple in most cases, then the diagnosis of MHE is less codified because of many differential diagnoses with different therapeutic implications. This review analyzes current knowledge about the pathophysiology, diagnosis, and different therapeutic options of HE., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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19. Optimal management of ascites.
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Rudler M, Mallet M, Sultanik P, Bouzbib C, and Thabut D
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- Diuretics therapeutic use, Humans, Liver Cirrhosis complications, Paracentesis, Quality of Life, Ascites etiology, Ascites therapy, Liver Transplantation
- Abstract
Ascites is the most common complication of cirrhosis, which develops in 5%-10% of patients per year. Its management is based on symptomatic measures including restriction of sodium intake, diuretics and paracentesis. Underlying liver disease must always be treated and may improve ascites. In some patients, ascites is not controlled by medical therapies and has a major impact on quality of life and survival. TIPS placement and liver transplantation must therefore be discussed. More recently, repeated albumin infusions and Alfapump
® have emerged as new therapies in ascites. In this review, the current data on these different options are analysed and an algorithm to help the physician make clinical decisions is suggested., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2020
- Full Text
- View/download PDF
20. Unsolved Questions in Salvage TIPSS: Practical Modalities for Placement, Alternative Therapeutics, and Long-Term Outcomes.
- Author
-
Bouzbib C, Sultanik P, Thabut D, and Rudler M
- Subjects
- Humans, Salvage Therapy, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage therapy, Liver Cirrhosis therapy, Portasystemic Shunt, Transjugular Intrahepatic
- Abstract
Salvage transjugular intrahepatic portosystemic shunt (TIPSS) has proven its efficacy to treat refractory variceal bleeding for patients with cirrhosis. However, this procedure is associated with very poor outcomes. As it is used as a last resort to treat a severe complication of cirrhosis, it seems essential to improve our practice, with the aim of optimizing management of those patients. Somehow, many questions are still unsolved: which stents should be used? Should a concomitant embolization be systematically considered? Is there any alternative therapeutic in case of recurrent bleeding despite TIPSS? What are the long-term outcomes on survival, liver transplantation, and hepatic encephalopathy after salvage TIPSS? Is this procedure futile in some patients? Is prognosis with salvage TIPSS nowadays as bad as earlier, despite the improvement of prophylaxis for variceal bleeding? The aim of this review is to summarize those data and to identify the lacking ones to guide further research on salvage TIPSS.
- Published
- 2019
- Full Text
- View/download PDF
21. [Metabolic encephalopathies].
- Author
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Marois C, Quirins M, Hermann B, Mouri S, Bouzbib C, Rudler M, Thabut D, and Weiss N
- Subjects
- Blood-Brain Barrier metabolism, Blood-Brain Barrier physiology, Brain diagnostic imaging, Brain metabolism, Brain physiopathology, Diagnosis, Differential, Diagnostic Techniques, Neurological, Drug-Related Side Effects and Adverse Reactions diagnosis, Drug-Related Side Effects and Adverse Reactions epidemiology, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy epidemiology, Humans, Neurotoxicity Syndromes diagnosis, Neurotoxicity Syndromes epidemiology, Neurotoxicity Syndromes etiology, Brain Diseases, Metabolic diagnosis, Brain Diseases, Metabolic epidemiology, Brain Diseases, Metabolic etiology
- Abstract
Metabolic encephalopathies (ME) are a common cause of admission to emergency rooms, to hospitalization wards or to intensive care units. They could account for 10 to 20% of causes of comatose states in ICU and could be associated to a poor outcome especially in older patients. Nevertheless, they are often reversible and are associated with a favorable outcome when diagnosed and rapidly treated. They correspond to an altered brain functioning secondary to the deficiency of a substance that is mandatory for the normal brain functioning or to the accumulation of a substance that can be either endogenous or exogenous. It preferably occurs in co-morbid patients, complicating its diagnosis and its management. Altered brain functioning, going from mild neuropsychological impairment to coma, movement disorders especially myoclonus and the absence of any obvious differential diagnosis are highly suggestive of the diagnosis. Whereas some biological samplings and brain MRI are essential to rule out differential diagnosis, some others, such as electroencephalogram, may be able to propose important clues in favor of the diagnosis. Once simple symptomatic measures are introduced, the treatment consists mainly in the correction of the cause. Specific treatment options are only seldom available for ME; this is the case for hepatic encephalopathy and some drug-induced encephalopathies. We will successively describe in this review the main pathophysiological mechanisms, the main causes, favoring circumstances of ME, the differential diagnosis to rule out and the etiological work-up for the diagnosis. Finally, a diagnostic and therapeutic strategy for the care of patients with ME will be proposed., (Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
22. Altered distal-proximal temperature gradient as a possible explanation for sleep-wake disturbances in cirrhotic patients.
- Author
-
Weiss N, Attali V, Bouzbib C, and Thabut D
- Subjects
- Humans, Liver Cirrhosis, Sleep, Sleep Wake Disorders, Temperature
- Published
- 2017
- Full Text
- View/download PDF
23. Bleeding from gastroduodenal metastases as the first manifestation of lung adenocarcinoma.
- Author
-
Bouzbib C, Chaput U, Jarrin I, Lavergne-Slove A, Marteau P, and Dray X
- Subjects
- Acute Disease, Anemia etiology, Duodenal Neoplasms diagnosis, Endoscopy, Gastrointestinal, Humans, Male, Middle Aged, Stomach Neoplasms diagnosis, Adenocarcinoma pathology, Duodenal Neoplasms secondary, Gastrointestinal Hemorrhage etiology, Lung Neoplasms pathology, Stomach Neoplasms secondary
- Published
- 2014
- Full Text
- View/download PDF
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