The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease

Hepatology International, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 27, 2025

Language: Английский

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Carvedilol as the new non‐selective beta‐blocker of choice in patients with cirrhosis and portal hypertension

Liver International, Journal Year: 2023, Volume and Issue: 43(6), P. 1183 - 1194

Published: March 10, 2023

Portal hypertension (PH) is the most common complication ofcirrhosis and represents main driver of hepatic decompensation. The overarching goal PH treatments in patients with compensated cirrhosis to reduce risk decompensation (i.e development ascites, variceal bleeding and/or encephalopathy). In decompensated patients, PH-directed therapies aim at avoiding further (i.e. recurrent/refractory rebleeding, recurrent encephalopathy, spontaneous bacterial peritonitis or hepatorenal syndrome) improving survival. Carvedilol a non-selective beta-blocker (NSBB) acting on hyperdynamic circulation/splanchnic vasodilation intrahepatic resistance. It has shown superior efficacy than traditional NSBBs lowering may be, therefore, NSBB choice for treatment clinically significant portal hypertension. primary prophylaxis bleeding, carvedilol been demonstrated be more effective endoscopic ligation (EVL). achieves higher rate hemodynamic response propranolol, resulting decreased secondary prophylaxis, combination EVL prevent rebleeding non-bleeding better that propranolol. ascites gastroesophageal varices, safe improve survival, as long no impairment systemic renal dysfunction occurs, maintained arterial blood pressure suitable safety surrogate. target dose treat should 12.5 mg/day. This review summarizes evidence behind Baveno-VII recommendations use cirrhosis.

Language: Английский

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Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Hepatology International, Journal Year: 2024, Volume and Issue: 18(2), P. 299 - 383

Published: Feb. 28, 2024

Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, has been further advanced Asian countries through the use living donor liver transplantation. This method only available option many Asia-Pacific region due to lack deceased organ donation. As result this situation, there growing need for guidelines that are specific region. These provide comprehensive recommendations evidence-based management throughout entire process transplantation, covering both In addition, development these collaborative effort between medical professionals from various allowed inclusion diverse perspectives experiences, leading more effective set guidelines.

Language: Английский

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Combination of carvedilol with variceal band ligation in prevention of first variceal bleed in Child-Turcotte-Pugh B and C cirrhosis with high-risk oesophageal varices: the ‘CAVARLY TRIAL’

Gut, Journal Year: 2024, Volume and Issue: 73(11), P. 1844 - 1853

Published: July 27, 2024

Objectives Beta-blockers and endoscopic variceal band ligation (VBL) have been preferred therapies for primary prophylaxis of bleeding. However, the choice therapy in patients with advanced liver disease high-risk varices is not clear. A comparison these alone or combination to prevent first bleed cirrhosis was carried out. Design 330 Child-Turcotte-Pugh (CTP) B C patients, ‘high-risk’ were prospectively enrolled (n=110 per group) receive carvedilol (group A), VBL B) C). Primary endpoint reduction incidence at 12 months. The secondary endpoints included overall mortality, bleed-related new-onset decompensation, change hepatic vein pressure gradient (HVPG) treatment-related adverse events. Results predominantly males (85.2%), aged 51.4±10.5 years CTP score 8.87±1.24, MELD 15.17±3.35 HVPG-16.96±3.57 mm Hg. 23.8% (n=78) 1 year. Intention-to-treat analysis showed that arm C) significantly reduced by 62.9% as compared group (HR 0.37, 95% CI 0.192 0.716, p<0.003) 69.3% 0.31, 0.163 0.578, <0.001). mortality 13.6% (45/330). 1-year lowest among three groups (A, B, C=20%, 14.5%, 6.3%, p=0.012). Reduction HVPG (20.8% vs 25.1%, p=0.54) rate non-response (53.4% 41.25%, p=0.154) different between patients. ascites, spontaneous bacterial peritonitis, shock, acute kidney injury postbleed organ failure also comparable groups. Conclusion In varices, more effective than either alone, prevention Trial registration number NCT03069339 .

Language: Английский

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Review article: controversies surrounding the use of carvedilol and other beta blockers in the management of portal hypertension and cirrhosis

Alimentary Pharmacology & Therapeutics, Journal Year: 2023, Volume and Issue: 57(5), P. 454 - 463

Published: Jan. 24, 2023

Summary Background Advanced chronic liver disease is an increasing cause of premature morbidity and mortality in the UK. Portal hypertension primary driver decompensation, including development ascites, hepatic encephalopathy variceal haemorrhage. Non‐selective beta blockers (NSBB) reduce portal pressure are well established prevention Carvedilol, a newer NSBB, more effective at reducing due to additional α‐adrenergic blockade has anti‐oxidant, anti‐inflammatory anti‐fibrotic effects. Aim To summarise available evidence on use blockers, specifically carvedilol, cirrhosis, focussing when why start Methods We performed comprehensive literature search PubMed for relevant publications. Results International guidelines advise NSBB prophylaxis against haemorrhage those with high‐risk varices, substantial efficacy comparable endoscopic band ligation (EBL). also secondary prophylaxis, combination EBL. More controversial their patients without large but clinically significant hypertension. However, there gathering that particularly risk decompensation improve survival. While caution advised advanced cirrhosis refractory recent suggests can continue be used safely, discontinuation may detrimental. Conclusions With benefit independent bleeding, namely retardation improvement survival, it time consider whether carvedilol should offered all disease.

Language: Английский

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Current challenges and future perspectives in treating patients with NAFLD-related cirrhosis

Hepatology, Journal Year: 2023, Volume and Issue: 80(5), P. 1270 - 1290

Published: May 15, 2023

Despite the slow, progressive nature of NAFLD, number patients with NAFLD-related cirrhosis has significantly increased. Although management is constantly evolving, improving prognosis a challenge because it situated at crossroads between liver, metabolic, and cardiovascular diseases. Therefore, therapeutic interventions should not only target liver but also associated cardiometabolic conditions be adapted accordingly. The objective current review to critically discuss particularities in cirrhosis. We relied on recommendations scientific societies discussed them specific context NAFLD surrounding milieu. Herein, we covered following aspects: (1) weight loss strategies through lifestyle avoid sarcopenia improve portal hypertension; (2) optimal control metabolic comorbidities particular type 2 diabetes aimed morbidity/mortality lower incidence cirrhosis-related complications (we various aspects related safety oral antidiabetic drugs cirrhosis); (3) challenges performing bariatric surgery hypertension risk decompensation; (4) diagnosis difficulties managing awaiting for transplantation; (5) developing conducting clinical trials Moreover, emerging options overcome these obstacles.

Language: Английский

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Managing cirrhosis with limited resources: perspectives from sub-Saharan Africa

˜The œLancet. Gastroenterology & hepatology, Journal Year: 2024, Volume and Issue: 9(2), P. 170 - 184

Published: Jan. 9, 2024

Language: Английский

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Hepatic immune regulation and sex disparities

Nature Reviews Gastroenterology & Hepatology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 5, 2024

Language: Английский

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Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

Frontiers in Medicine, Journal Year: 2023, Volume and Issue: 9

Published: Jan. 9, 2023

With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, beneficial effect carvedilol, which blocks alpha beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment beta-arrestin. This its consequences not sufficiently investigated patients cirrhosis. Also, number questions remain open regarding expression beta-receptors intracellular signaling respective intra- extrahepatic tissue compartments. Despite undisputed role treatment cirrhosis, we still can improve knowledge as when how should be used patients.

Language: Английский

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Long-Term Outcomes of Carvedilol Plus Endoscopic Variceal Ligation in Secondary Prophylaxis of Variceal Bleeding

Digestive Diseases and Sciences, Journal Year: 2025, Volume and Issue: unknown

Published: April 3, 2025

Language: Английский

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