Percutaneous liver biopsy is a proven way to rate the fibrosis stage both in hepatitis in chronic hepatitis C patients and hepatitis B patients. But it is uncomfortable for patients, risks complications and is prone to assembling errors.
Reporting at ID Week 2015 in San Diego, CA, Tuma Demirdal, DR, and colleagues at the Katip Celebi University in Izmir, Turkey compared these invasive tests with non-invasive methods.
They looked at 236 patients with chronic hepatitits C and hepatitis B who had ultrasound guided liver biopsy over a seven year period Histological grading of necroinflammation and fibrosis ere performed according to Knodell an ISAK scoring systems. APRI, n-APRI, FIB-4, FI scores were calculated.
Read more....
Showing posts with label Fibrosis. Show all posts
Showing posts with label Fibrosis. Show all posts
Tuesday, October 13, 2015
Thursday, October 1, 2015
The Five: Coffee —Alan Franciscus, Editor-in-Chief
In celebration of National Coffee Day.....but remember adding a bunch of sugar and cream most likely eliminates the benefits! Alan
For some people that morning cup of Joe is the perfect way to start the day. Surprisingly, there are many published studies that show that caffeinated coffee can improve the health of the liver and provide other health benefits. There are some caveats to these health claims that I will discuss at the end of this article. First let’s talk about the good news—the possible health benefits:
1. Liver Fibrosis / HCV Disease Progression:
In a review of 177 patients—121 patients with HCV who drank about 2 ¼ cups of coffee a day were found to have reduced levels of liver fibrosis. The results were only found in those who drank caffeinated coffee.
In another review, 766 participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial found more good news. Those who had hepatitis C-related bridging fibrosis or cirrhosis on a liver biopsy and who failed to achieve a cure after being treated with pegylated interferon and ribavirin therapy also yielded some surprising results. Those with advanced liver disease who regularly consumed coffee were found to have lower rates of HCV disease progression.
2. Liver Cancer:
A small study found that people who drank one to three cups of coffee a day had a 29% lower risk of developing liver cancer compared to those who drank 6 cups or less a week.
Another study which reviewed 16 different studies involving over 3,200 patients found that drinking more than 3 cups of coffee a day might cut the risk of liver cancer by up to 50%.
3. Other Conditions:
There are many studies that show a link between the reduction or prevention of certain types of cancers and drinking caffeinated coffee (skin, breast, colon, prostate, uterine, oral). There are also studies that show that caffeinated coffee can lower the risk of diabetes and death.
4. The Downside:
Now, I am going to burst the bubble! Coffee, specifically caffeine, is a drug (a stimulant). Moreover, with any drug you can have withdrawal: It can take more than eight weeks to withdraw entirely from caffeine—although, caffeine withdrawal is usually just an annoying headache and some light fatigue.
Drinking or consuming caffeine can raise blood pressure, lead to heart arrhythmia (irregular heartbeats), can cause cramps, diarrhea and other gastrointestinal health issues. If you drink it too close to bedtime, it can cause insomnia. Too much caffeine can cause depression, anxiety and other types of nervous behaviors. Although rare there have been serious health consequences from people drinking energy drinks and shots.
Examples of the typical amount of caffeine:*
*http://www.nlm.nih.gov/medlineplus/ ency/article/002445.htm
There are many other side effects of caffeine, but I will stop here. However, for most people caffeine in moderation is safe and well-tolerated!
5. Final Thoughts:
What does all of this mean? It is hard to draw concrete conclusions from these studies because you cannot measure what people drink, how it is made and what chemicals are in the coffee. However, there must be something in caffeinated coffee that is contributing to all of these positive outcomes. There are over 1,000 natural chemicals in coffee, and some of these chemicals may be contributing to the caffeine and providing these benefits. Scientists are studying the various chemicals, and we may soon have more concrete information that may lead the way to more potent medications to treat many conditions. In the meantime, it could not hurt to have a cup of Joe—that is if your health allows it.
For some people that morning cup of Joe is the perfect way to start the day. Surprisingly, there are many published studies that show that caffeinated coffee can improve the health of the liver and provide other health benefits. There are some caveats to these health claims that I will discuss at the end of this article. First let’s talk about the good news—the possible health benefits:
1. Liver Fibrosis / HCV Disease Progression:
In a review of 177 patients—121 patients with HCV who drank about 2 ¼ cups of coffee a day were found to have reduced levels of liver fibrosis. The results were only found in those who drank caffeinated coffee.
In another review, 766 participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial found more good news. Those who had hepatitis C-related bridging fibrosis or cirrhosis on a liver biopsy and who failed to achieve a cure after being treated with pegylated interferon and ribavirin therapy also yielded some surprising results. Those with advanced liver disease who regularly consumed coffee were found to have lower rates of HCV disease progression.
2. Liver Cancer:
A small study found that people who drank one to three cups of coffee a day had a 29% lower risk of developing liver cancer compared to those who drank 6 cups or less a week.
Another study which reviewed 16 different studies involving over 3,200 patients found that drinking more than 3 cups of coffee a day might cut the risk of liver cancer by up to 50%.
3. Other Conditions:
There are many studies that show a link between the reduction or prevention of certain types of cancers and drinking caffeinated coffee (skin, breast, colon, prostate, uterine, oral). There are also studies that show that caffeinated coffee can lower the risk of diabetes and death.
4. The Downside:
Now, I am going to burst the bubble! Coffee, specifically caffeine, is a drug (a stimulant). Moreover, with any drug you can have withdrawal: It can take more than eight weeks to withdraw entirely from caffeine—although, caffeine withdrawal is usually just an annoying headache and some light fatigue.
Drinking or consuming caffeine can raise blood pressure, lead to heart arrhythmia (irregular heartbeats), can cause cramps, diarrhea and other gastrointestinal health issues. If you drink it too close to bedtime, it can cause insomnia. Too much caffeine can cause depression, anxiety and other types of nervous behaviors. Although rare there have been serious health consequences from people drinking energy drinks and shots.
Examples of the typical amount of caffeine:*
- Coffee – 100 mg per cup
- Tea – 14 mg to 60 mg per cup
- Chocolate – 45 mg in 1.5 oz bar
- Most colas (unless they are labeled “caffeine-free”) – 45 mg in 12 oz. drink
- Candies, energy drinks, snacks, gum – 40-100 mg per serving
*http://www.nlm.nih.gov/medlineplus/ ency/article/002445.htm
There are many other side effects of caffeine, but I will stop here. However, for most people caffeine in moderation is safe and well-tolerated!
5. Final Thoughts:
What does all of this mean? It is hard to draw concrete conclusions from these studies because you cannot measure what people drink, how it is made and what chemicals are in the coffee. However, there must be something in caffeinated coffee that is contributing to all of these positive outcomes. There are over 1,000 natural chemicals in coffee, and some of these chemicals may be contributing to the caffeine and providing these benefits. Scientists are studying the various chemicals, and we may soon have more concrete information that may lead the way to more potent medications to treat many conditions. In the meantime, it could not hurt to have a cup of Joe—that is if your health allows it.
Tuesday, September 29, 2015
THE FIVE: Cirrhosis —Alan Franciscus, Editor-in-Chief
This month’s column is about cirrhosis—the causes, how it develops, the symptoms and
consequences and issues about HCV treatment related to cirrhosis.
1. What are the Causes of Cirrhosis?
Cirrhosis is caused by many substances (alcohol), viruses (hepatitis B, C and D), and even by metabolic disorders (diabetes). Currently, the most common reason for liver transplantation in the United States is from complications from the hepatitis C virus. Cirrhosis caused by hepatitis C is responsible for more than 19,000 deaths every year. Prior to the emergence of hepatitis C, the most common cause of cirrhosis was alcohol consumption. Fatty liver is also a common cause of cirrhosis, and it is expected to surpass the hepatitis C virus as the most common cause of cirrhosis and liver transplantation in the next two decades.
2. How Does Cirrhosis Develop?
In the case of hepatitis C, the development of cirrhosis is a complex process of liver cells becoming damaged or destroyed by the hepatitis C virus. Furthermore, the body’s immune system seeks out and identifies the hepatitis C virus (and the destroyed liver cell) as a foreign pathogen—attacks it and kills it. As a result, scar tissue develops. Usually, the liver can repair itself, but as the hepatitis C virus causes more and more damage, it overwhelms the body and the damage builds and builds. As more scar tissue develops the damaged cells start to connect, and fibrosis develops. Over time, the scar tissue can be so extensive that it can interfere with the functioning of the liver. This is called cirrhosis. Cirrhosis is classified into two types: compensated and decompensated. Compensated means that the liver is extensively scarred but can still perform most of its functions; decompensated means that the liver is extensively scarred and unable to perform many of the functions that keep the body healthy.
3. What are the Tests to Identify Cirrhosis?
There are many types of tests to find out if someone has cirrhosis. In the past, the most common test was a liver biopsy. The procedure requires a medical person to insert a needle through the skin to extract a piece of liver tissue and examine it under a microscope. The liver biopsy is still being used, but it is also being replaced by other procedures such as a Fibroscan (an imaging test), Fibrometer (combination of blood tests), and other blood tests to gauge the degree of liver damage.
There are many models used to grade and stage the degree of liver damage. The most common is the Metavir. The Metavir has an inflammation and fibrosis scoring stage—in this article I am just listing the fibrosis stages:
Note: This is important to know because many insurance companies are using this system to approve or deny insurance for HCV treatment claims.
4. What are the Symptoms and Consequences of Cirrhosis?
In the early stages of extensive scarring—called compensated cirrhosis—the symptoms may be similar to hepatitis C—fatigue, loss of appetite, muscle and joint pain, flu-like symptoms, nausea, indigestion, headaches and many other symptoms. As cirrhosis develops and reaches the later stages—called decompensated cirrhosis—the symptoms become more pronounced and can become life-threatening. In addition to the symptoms described above I have listed some of the more common serious conditions below:
Most of these conditions can be managed effectively with lifestyle changes, medications and medical procedures—at least in the short term. The most important step is to be medically monitored and managed on a regular basis. At this point, a person should be evaluated for a liver transplant. The problem is that there are only an estimated 6,000 available livers for the estimated 15,000 livers needed every year for transplantation in the U.S.
5. HCV Treatment
Hepatitis C treatment can now cure most people, the treatment duration is shorter, and treatment side effects are lower than ever. However, once people develop cirrhosis, it becomes more difficult especially for those who are infected with genotype 3 and who have cirrhosis—the second most prevalent genotype in the United States. Unfortunately, we also know that many insurance companies are denying coverage of hepatitis C medications to only those who are in the early stages of HCV infections (F0, F1, F2). Many insurance companies are only covering F3 and F4 unless there are other severe complications. Here’s the problem—if you wait until stage F3 or F4 and are cured you will have to be medically followed for the rest of your life since there is a possibility that you could still have liver disease progression. However, if you are treated early (F0, F1, F2), and cured you are free of future complications. Does this scenario make any sense to you? It does not make any sense to me either!
consequences and issues about HCV treatment related to cirrhosis.
1. What are the Causes of Cirrhosis?
Cirrhosis is caused by many substances (alcohol), viruses (hepatitis B, C and D), and even by metabolic disorders (diabetes). Currently, the most common reason for liver transplantation in the United States is from complications from the hepatitis C virus. Cirrhosis caused by hepatitis C is responsible for more than 19,000 deaths every year. Prior to the emergence of hepatitis C, the most common cause of cirrhosis was alcohol consumption. Fatty liver is also a common cause of cirrhosis, and it is expected to surpass the hepatitis C virus as the most common cause of cirrhosis and liver transplantation in the next two decades.
2. How Does Cirrhosis Develop?
In the case of hepatitis C, the development of cirrhosis is a complex process of liver cells becoming damaged or destroyed by the hepatitis C virus. Furthermore, the body’s immune system seeks out and identifies the hepatitis C virus (and the destroyed liver cell) as a foreign pathogen—attacks it and kills it. As a result, scar tissue develops. Usually, the liver can repair itself, but as the hepatitis C virus causes more and more damage, it overwhelms the body and the damage builds and builds. As more scar tissue develops the damaged cells start to connect, and fibrosis develops. Over time, the scar tissue can be so extensive that it can interfere with the functioning of the liver. This is called cirrhosis. Cirrhosis is classified into two types: compensated and decompensated. Compensated means that the liver is extensively scarred but can still perform most of its functions; decompensated means that the liver is extensively scarred and unable to perform many of the functions that keep the body healthy.
3. What are the Tests to Identify Cirrhosis?
There are many types of tests to find out if someone has cirrhosis. In the past, the most common test was a liver biopsy. The procedure requires a medical person to insert a needle through the skin to extract a piece of liver tissue and examine it under a microscope. The liver biopsy is still being used, but it is also being replaced by other procedures such as a Fibroscan (an imaging test), Fibrometer (combination of blood tests), and other blood tests to gauge the degree of liver damage.
There are many models used to grade and stage the degree of liver damage. The most common is the Metavir. The Metavir has an inflammation and fibrosis scoring stage—in this article I am just listing the fibrosis stages:
- Stage F0 = no fibrosis
- Stage F1 = mild fibrosis
- Stage 2 = moderate fibrosis
- Stage 3 = bridging fibrosis
- Stage 4 = cirrhosis
Note: This is important to know because many insurance companies are using this system to approve or deny insurance for HCV treatment claims.
4. What are the Symptoms and Consequences of Cirrhosis?
In the early stages of extensive scarring—called compensated cirrhosis—the symptoms may be similar to hepatitis C—fatigue, loss of appetite, muscle and joint pain, flu-like symptoms, nausea, indigestion, headaches and many other symptoms. As cirrhosis develops and reaches the later stages—called decompensated cirrhosis—the symptoms become more pronounced and can become life-threatening. In addition to the symptoms described above I have listed some of the more common serious conditions below:
- Portal Hypertension: blood cannot flow through the liver because of the extensive scarring.
- Encephalopathy: the liver is not able to remove toxins such as ammonia, and the result is that these toxins invade the brain. Symptoms include personality changes, and changes in sleep patterns (sleep reversal—awake all night, sleep all day).
- Ascites: accumulation of fluids in the abdominal cavity.
- Edema: accumulation of fluid in the extremities—usually in the feet and legs.
- Coagulopathy: the liver is not able to produce clotting factors that stop the blood from bleeding.
- Male and Female Hormone Regulation: the liver may not be able to regulate female and male hormones.
- Severe Itching: the impairment of bile flow that can cause severe and at times debilitating itching.
- Wasting Syndrome: the liver is not able to process nutrients so people can have severe muscle wasting and weight loss.
Most of these conditions can be managed effectively with lifestyle changes, medications and medical procedures—at least in the short term. The most important step is to be medically monitored and managed on a regular basis. At this point, a person should be evaluated for a liver transplant. The problem is that there are only an estimated 6,000 available livers for the estimated 15,000 livers needed every year for transplantation in the U.S.
5. HCV Treatment
Hepatitis C treatment can now cure most people, the treatment duration is shorter, and treatment side effects are lower than ever. However, once people develop cirrhosis, it becomes more difficult especially for those who are infected with genotype 3 and who have cirrhosis—the second most prevalent genotype in the United States. Unfortunately, we also know that many insurance companies are denying coverage of hepatitis C medications to only those who are in the early stages of HCV infections (F0, F1, F2). Many insurance companies are only covering F3 and F4 unless there are other severe complications. Here’s the problem—if you wait until stage F3 or F4 and are cured you will have to be medically followed for the rest of your life since there is a possibility that you could still have liver disease progression. However, if you are treated early (F0, F1, F2), and cured you are free of future complications. Does this scenario make any sense to you? It does not make any sense to me either!
Friday, September 4, 2015
Diabetes and Fatty Liver Associated with Further Liver Problems--- Adding liver fibrosis to the long list of diabetic complications under consideration...
A recent study published in Hepatology evaluated various risk factors for liver fibrosis in a Dutch population. The call for concern is the prevalence of liver fibrosis in a patient population with low prevalence of hepatitis—the usual suspect of causation.
Some links have shown non-alcoholic liver disease has a connection to liver fibrosis. Certainly, identifying modifiable risk factors and their impact in developing liver problems can be important to targeting change.
The prospective cohort study was conducted over two years in Rotterdam on 3,041 patients, 45 years or older. Abdominal ultrasounds were used to scan their livers and evaluate liver stiffness to characterize potential fibrosis. Further collections of blood, anthropometric measures, medical history, demographics, drug use, alcohol consumption, smoking history and comorbidities were evaluated.
Just over one-third (35.5%) of the patients had the presence of fatty liver and 5.6% of the patients had a liver stiffness over 8 kPa or clinically relevant for liver fibrosis. Not surprisingly, having the presence of positive surface antigens for hepatitis B or C resulted in a five-fold increased chance in also having liver fibrosis
Read more.....
Some links have shown non-alcoholic liver disease has a connection to liver fibrosis. Certainly, identifying modifiable risk factors and their impact in developing liver problems can be important to targeting change.
The prospective cohort study was conducted over two years in Rotterdam on 3,041 patients, 45 years or older. Abdominal ultrasounds were used to scan their livers and evaluate liver stiffness to characterize potential fibrosis. Further collections of blood, anthropometric measures, medical history, demographics, drug use, alcohol consumption, smoking history and comorbidities were evaluated.
Just over one-third (35.5%) of the patients had the presence of fatty liver and 5.6% of the patients had a liver stiffness over 8 kPa or clinically relevant for liver fibrosis. Not surprisingly, having the presence of positive surface antigens for hepatitis B or C resulted in a five-fold increased chance in also having liver fibrosis
Read more.....
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