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Bhatia V.,Institute of Liver and Biliary science ILBS
Journal of Clinical and Experimental Hepatology | Year: 2012

A large part of portal venous system and the paragastric and para-esophageal collateral circulation is within the reach of endoscopic ultrasound (EUS). The EUS is more sensitive than gastroscopy for the detection of gastric varices (GV), and can accurately distinguish GV from thickened gastric folds. Gastric varices are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger collateral channels visible outside the gastric wall. The EUS has also been used to monitor the completeness of GV obturation after glue injection. There are limited data that this strategy may be clinically beneficial to prevent GV re-bleed. The EUS has been used to deliver glue injections under real-time monitoring into the vascular channels, with or without steel coils as scaffolding for the glue. The potential advantages of this technique include a straight scope position, lack of hindrance from pooled blood in gastric fundus, smaller glue volume requirements, and precise intra-vascular placement of glue with avoidance of intramural injections, and reduced embolic complications. © 2012 INASL.

Kumar R.,Institute of Liver and Biliary science ILBS
Hepatology International | Year: 2013

Non-alcoholic fatty liver disease (NAFLD), once regarded as an innocuous condition, is now considered to be the most common cause of chronic liver disease worldwide. Evidence suggests a strong association between NAFLD and other potentially life-threatening diseases. A significant proportion of these patients develops progressive liver injury leading to cirrhosis and hepatocellular carcinoma. Unrecognized NAFLD constitutes a substantial proportion of patients with cryptogenic cirrhosis. Several large community-based studies have found increased mortality in NAFLD patients compared to the expected mortality of the general population of the same age and sex. Cardiovascular disease is an important cause of morbidity and mortality in patients with NAFLD and accounts for up to 30 % of overall death. Cardiovascular mortality does not seem to differ between simple steatosis and non-alcoholic steatohepatitis. NAFLD is associated with increased risk of both hepatic and extra-hepatic malignancy. Malignancy is among the most important causes of death in NAFLD patients. NAFLD is a risk factor for liver cancer even without cirrhosis. The steatotic liver has poor ability to regenerate after volume loss, which may lead to the development of liver failure and increased mortality after extended liver resection. Also, transplantation of steatotic liver results in an increased rate of poor graft function, primary graft non-function, and poorer outcome. There is a high recurrence rate of fatty liver disease in patients transplanted for NASH. © 2013 Asian Pacific Association for the Study of the Liver.

Angeli P.,University of Padua | Sanyal A.,Virginia Commonwealth University | Moller S.,Copenhagen University | Alessandria C.,University of Turin | And 4 more authors.
Liver International | Year: 2013

Advanced cirrhosis is often complicated by a multi organ failure syndrome which involves many different organs besides the liver. The high morbidity and mortality secondary to this clinical setting is often related to renal dysfunction, either alone or, more frequently, in combination with other organ dysfunction. A clear defintion of renal dysfunction, an accurate differential diagnostic process of its different phenotypes as well as of full understanding of its pathophysiological mechanisms are crucial to the development of strategies for the management of this complication. This article is based either on the more recent knowledge on renal dysfunction in advanced cirrhosis or current opinions among the members of the International Club of Ascites (ICA) on the management of this complication, obtained through a survey and discussed during the EASL-ICA Joint Meeting in Berlin in March 2011. It reviews critically our current knowledge and it outlines future perspectives, on the management of renal dysfunction in patients with cirrhosis. © 2012 John Wiley & Sons A/S.

Bhatia V.,Institute of Liver and Biliary science ILBS
Journal of Clinical and Experimental Hepatology | Year: 2014

Portal cavernoma cholangiopathy (PCC) refers to a constellation of secondary changes in the biliary tree in patients with chronic portal vein (PV) thrombosis and portal cavernoma formation. These findings of PCC are seen in the extra-hepatic bile duct(s), with or without involvement of the 1st or 2nd degree intra-hepatic bile ducts.Of all patients with chronic PV thrombosis, cholangiographic features of PCC are found in 80%-100%. The biliary changes are symptomatic in a smaller proportion of 5%-38% patients. Choledocholithiasis and hepatolithiasis occur in 5%-20%, independent of the occurrence of cholelithiasis. We review the published literature on cholangiographic description of PCC. We also propose standardized nomenclature for the cholangiographic findings, namely: extrinsic impressions/indentations, shallow impressions, irregular ductal contour, stricture (s), upstream dilatation, filling defects, bile duct angulation, and ectasia. © 2013 INASL.

Saha B.,Institute of Liver and Biliary science ILBS | Saha B.,University of Massachusetts Medical School | Choudhary M.C.,Institute of Liver and Biliary science ILBS | Sarin S.K.,Institute of Liver and Biliary science ILBS
AIDS | Year: 2013

Objective: Hepatitis C virus (HCV)/HIV coinfection is associated with rapid progression of hepatic fibrosis and liver disease. T-cell response has been implicated in the pathophysiological outcome of the disease. Design: This study sought to evaluate the role of memory T-cell exhaustion in enhancing immune dysfunction during coinfection. Methods: Sixty-four patients were included in the study; HCV monoinfected (n=21), HIV monoinfected (n=23), HCV/HIV coinfected (n=20), and healthy controls (n=20). Peripheral blood mononuclear cells (PBMCs) were isolated; immunophenotyped and functional assays were performed. Results: A significant increase in the naive T cells and central memory T cells and a marked reduction in effector memory T cells (TEM) were observed with coinfection as compared to monoinfection. Inhibitory markers programmed death 1 (PD-1) and T-cell immunoglobulin and mucin domain containing molecule 3 (TIM3) were highly upregulated on TEM in coinfection and functionally, these TEM cells displayed lowered proliferation. Increased expression of PD-1 and TIM3 correlated with decreased levels of CD8+CD107a + TEM cells in coinfection. Pro-inflammatory cytokines interferon-g and interleukin-2 (IL-2) secretion by TEM cells were also reduced during chronic viral infection. Secretion of IL-10, a human cytokine synthesis inhibitory factor, was significantly upregulated in CD4 + TEM with HCV/HIV coinfection in comparison to HCV monoinfection. Conclusion: TEM cells play an important role during viral infection and enhanced expression of inhibitory markers is associated with decreased proliferation and cytotoxicity and increased IL-10 production, which was pronounced in HCV/HIV coinfection. Thus, decreased TEM functionality contributes to diminished host immune responses during HCV/HIV coinfection as compared to HCV or HIV monoinfection. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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