Search

Background and Objectives: Chronic hepatitis C virus (HCV) infection is intricately linked with dysregulation of lipid metabolism. In particular, cholesterol plays a crucial role in HCV replication. Direct-acting antiviral agents (DAAs) therapy has revolutionized the hepatitis C treatment landscape, achieving high rates of sustained virological response (SVR). However, viral clearance comes with some alterations in lipid-related markers. This prospective study aimed to evaluate the impact of HCV clearance on lipid homeostasis and non-invasive liver fibrosis markers in hepatitis C patients treated with DAAs. Material and Methods: Fifty-two patients with varying degrees of fibrosis treated with DAAs therapy were evaluated at baseline and 24 weeks post-SVR. Lipid profiles and non-invasive liver fibrosis markers were assessed. Results: Our findings revealed an increase in total cholesterol, triglyceride, and LDLc (low-density lipoprotein cholesterol) levels at 24 weeks post-SVR, alongside an improvement in serum liver enzymes. Although improvements in liver stiffness were observed in non-invasive tests, there was an increase in lipid-related markers post-SVR. Conclusions: This suggests a potential increased cardiovascular risk despite improvements in liver function and fibrosis, highlighting the necessity for statin therapy in some cases and extended follow-ups for these patients. These findings underscore the importance of closely monitoring lipid profiles in chronic hepatitis C patients post-SVR, as well as the potential need for statin therapy to mitigate cardiovascular risk. Additionally, extended follow-up is essential to assess long-term outcomes and ensure the optimal management of these patients. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatocellular carcinoma (HCC) is a significant public health issue, with an increasing incidence and prevalence and a high incidence-to-mortality ratio. The prognosis of HCC depends on two competing factors, tumor burden and underlying liver disease severity, encompassed in the Barcelona Clinic Liver Cancer (BCLC) classification. To assess HCC staging and the way staging affects eligibility for treatment at the time of the first diagnosis in Romania in the setting of opportunistic diagnosis, in the absence of a national HCC screening policy. Methods: Data regarding HCC staging, underlying liver disease, and eligibility for treatment at the time of diagnosis was analyzed using a prospectively maintained multicentric database, which included patients from the five largest tertiary care hepatology units in the country between June 2016 and February 2020. Results: A consecutive series of 477 patients was included. The distribution within BCLC classes was as follows: very early (0) 7.1%, early (A) 34.3%, intermediate (B) 19.4%, advanced (C) 14.2%, terminal (D) 24.7%. At the time of the diagnosis, 198 (41.5%) were eligible for a curative intent treatment, while 359 (75.2%) were eligible for a disease-modifying therapy. 228 patients (47.8%) had decompensated liver disease at the time of diagnosis, the most common decompensating event being ascites (78.1%). Conclusions: A large proportion of HCC cases are diagnosed at the time of a decompensating event, severely restricting the therapeutic potential. Proactive diagnostic strategies should be implemented to improve the rate of actionable diagnosis. [ABSTRACT FROM AUTHOR]

Aim: Portal vein thrombosis is a frequent complication of liver cirrhosis. The aim is to evaluate the frequency of PVT in cirrhosis and the sensitivity of CEUS in the characterization of PVT. Material and methods: We performed a retrospective study including 730 patients with liver cirrhosis admitted to the Department of Gastroenterology of SCJUT between January 2016-December 2017, respectively 450 men (61.6%) and 280 women (38.4%), mean age 61.7 ± 10.57 years. The parameters followed were: Child-Pugh score, presence of portal vein thrombosis, HCC. The diagnosis of portal thrombosis was determined by ultrasound examination by an expert in the field. The nature of portal vein thrombosis was assessed by contrast-enhanced ultrasound (CEUS), confirmed by another imaging method with contrast (CT scan/MRI). Results: According to the stage of the disease, the patients were Child Pugh class A-29.8%; Class B -38.9% and Class C - 31.3%. Out of the 730 patients with cirrhosis, 79 (10.8%) had portal vein thrombosis described by ultrasound. Portal vein thrombosis was complete in 35/79 patients (44.3%) and partial in 44/79 (55.7%) cases. CEUS examination of portal thrombosis showed 54 malignant portal vein thrombosis (68.3%) and 25 benign portal vein thrombosis (31.7%). 94.1% (51/54) of patients with malignant portal thrombosis had hepatocellular carcinoma. Esophageal and gastric varices were present in 61/79 patients with portal vein thrombosis (77.2%). 39.3% of these patients (24/61) had a history of upper gastrointestinal bleeding by variceal rupture p<.0001. Conclusions: Portal vein thrombosis was present in 10.8% of cirrhotic patients. CEUS is a sensitive method for the characterization of PVT in cirrhotic patients. 68.3% of cases the thrombosis was malignant and was associated with hepatocellular carcinoma. Portal vein thrombosis in patients with esophageal and gastric varices is associated with increased risk of upper gastrointestinal bleeding due to variceal rupture p<.0001. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the enhancement pattern of cholangiocellular carcinoma (CCC) on contrast enhanced ultrasound (CEUS). Methods: This observational retrospective study included 50 patients diagnosed with CCC between 2010-2018. The final diagnosis of CCC was established by an imaging method (contrast enhanced CT or MRI) or biopsy. All 50 patients with CCC were examined by CEUS (22 men, 38 women, mean age 64.3±10.9 years); only 5 patients had liver cirrhosis and 2 patients with chronic hepatopathy with severe fibrosis. CEUS was considered conclusive for CCC if a typical pattern was present (EFSUMB criteria). Results: In the arterial phase the enhancement patters were: a) Rim-like enhancement: irregular peripheral hyper-enhancement and nonenhancing regions 18/50 cases (36%); b) Homogeneous hyperenhancement in 11/50 cases (22%); c) Heterogeneous hyperenhancementmixed irregular hyper-enhancement in both the peripheral and central parts of the lesion and nonenhancing regions in 12/50 cases (24%); d) Isoenhancement in 2/50 cases (4%); e) Hypoenhancement in 7/50 cases (14%). In the portal phase washout was observed in 34/50 (68%) cases, isoenhancement in 7/50 cases (14%), hypoenhacement in 7/50 cases (14%) and hyperenhancing pattern in 2/50 (4%) cases. In the late phase washout was observed in 40/50 (80%) cases, hypoenhacement in 8/50 cases (16%), isoenhancement in 1/50 cases (2%) and hyperenhancing pattern in 1/50 cases (2%). In 44% (22/50 cases) CEUS was conclusive for the diagnosis of CCC, 25 lesions were inconclusive on CEUS and 3 (6%) lesions were misdiagnosed. After CEUS examination all 25 inconclusive lesions were classified as malignant. Conclusions: 60% of CCC cases had rim-like and heterogeneous enhancement in the arterial phase. Washout was present in the late vascular phase in 80% of cases. After CEUS examination a conclusive result for the diagnosis of CCC was obtained in 44% cases. All inconclusive lesions on CEUS were classified as malignant. [ABSTRACT FROM AUTHOR]