Physicians’ practices for diagnosing liver fibrosis in chronic liver diseases: A nationwide, Canadian survey

Original Articles
January 2014, Volume 28 Issue 1: 23- 30

G Sebastiani | P Ghali | P Wong | MB Klein | M Deschenes | RP Myers

OBJECTIVE: To determine practices among physicians in Canada for the assessment of liver fibrosis in patients with chronic liver diseases.

METHODS: Hepatologists, gastroenterologists, infectious diseases specialists, members of the Canadian Gastroenterology Association and/or the Canadian HIV Trials Network who manage patients with liver diseases were invited to participate in a web-based, national survey.

RESULTS: Of the 237 physicians invited, 104 (43.9%) completed the survey. Routine assessment of liver fibrosis was requested by the surveyed physicians mostly for chronic hepatitis C (76.5%), followed by autoimmune/cholestatic liver disease (59.6%) and chronic hepatitis B (52.9%). Liver biopsy was the main diagnostic tool for 46.2% of the respondents, Fibroscan (Echosens, France) for 39.4% and Fibrotest (LabCorp, USA) for 7.7%. Etiology-specific differences were observed: noninvasive methods were mostly used for hepatitis C (63% versus 37% liver biopsy) and hepatitis B (62.9% versus 37.1% liver biopsy). For 42.7% of respondents, the use of noninvasive methods reduced the need for liver biopsy by >50%. Physicians’ characteristics associated with higher use of noninvasive methods were older age and being based at a university hospital or in private practice versus community hospital. Physicians’ main concerns regarding noninvasive fibrosis assessment methods were access/availability (42.3%), lack of guidelines for clinical use (26.9%) and cost/lack of reimbursement (14.4%).

CONCLUSIONS: Physicians who manage patients with chronic liver diseases in Canada require routine assessment of liver fibrosis stage. Although biopsy remains the primary diagnostic tool for almost one-half of respondents, noninvasive methods, particularly Fibroscan, have significantly reduced the need for liver biopsy in Canada. Limitations in access to and availability of the noninvasive methods represent a significant barrier. Finally, there is a need for clinical guidelines and a better reimbursement policy to implement noninvasive tools to assess liver fibrosis.

Canadian physicians | Chronic liver diseases | Liver biopsy | Liver fibrosis | Noninvasive fibrosis methods

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Multiple Factors Predict Physical Performance in People with Chronic Liver Disease

Am J Phys Med Rehabil. 2014 Jan 6. [Epub ahead of print]

Loria A, Doyle K, Weinstein AA, Winter P, Escheik C, Price J, Wang L, Birerdinc A, Baranova A, Gerber L, Younossi ZM.

Abstract

OBJECTIVE: The aim of this study was to assess whether physical performance correlates with metabolic and inflammatory measures in research subjects with chronic liver disease.

DESIGN: This is a prospective, descriptive cohort study correlating performance on a 6-min walk test with cardiorespiratory variables, metabolic measures (glucose [GLU], C-peptide insulin, and lipids), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and the proinflammatory cytokine interleukin-8 (IL-8).

RESULTS: This study enrolled 51 subjects (18 women) with chronic liver disease: 41% (n = 21) with nonalcoholic fatty liver disease and 59% (n = 30) with hepatitis C virus. Age, resting heart rate, and fasting GLU correlated significantly with distance walked (P's < 0.05). First quartile "poor performers" (n = 14) and fourth quartile "high performers" (n = 14) showed differences in age, sex, fasting GLU, and IL-8 level (P's < 0.05). Combining the number of abnormal serum values (IL-8, C-peptide insulin, GLU, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein, triglyceride, and total cholesterol) did not correlate with distance walked (P > 0.90). However, in multiple regression analysis, a model that included sex, age, resting heart rate, IL-8 level, and fasting GLU level explained approximately 39% of the variance in the distance walked during the test.

CONCLUSIONS: Older age, female sex, abnormal levels of the proinflammatory cytokine IL-8, abnormalities of GLU metabolism, and high resting heart rate are associated with poor physical performance in subjects with chronic liver disease. Poor physical performance is associated with physiologic, metabolic, and inflammatory abnormalities in subjects with nonalcoholic fatty liver disease and hepatitis C virus.

PMID: 24398583 PubMed - as supplied by publisher]

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Coffee Consumption and Chronic Liver Disease: The New Best Prescription?

Medscape Gastroenterology > Viewpoints

David A. Johnson, MD

January 06, 2014

Review Article: Coffee Consumption, the Metabolic Syndrome and Non-alcoholic Fatty Liver Disease

Yesil A, Yilmaz Y
Aliment Pharmacol Ther. 2013;38:1038-1044

Study Summary

Coffee consumption is a part of daily life in most areas of the world. As such, a number of studies have evaluated the chemical composition and related effects that this enjoyable beverage may have on health and disease.

For many years, healthcare providers have advised patients to avoid excessive consumption because of a concern about caffeine dependence. Several recent studies, however, suggest that regular coffee consumption may modulate the risk for fibrosis in chronic liver disease.

Yesil and Yilmaz analyzed the experimental, epidemiologic, and clinical studies and the modulation of the metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). Animal studies showed a reduction in the metabolic syndrome with improvements in glycemic and lipid regulation, as well as reductions in transaminases and proinflammatory cytokine hepatic gene expression. Other studies showed reductions in hepatic fat and collagen proinflammatory tumor necrosis factor, as well as increases in anti-inflammatory interleukins. Epidemiologic and clinical studies demonstrated a significant inverse association between coffee consumption and prevalence of metabolic syndrome, as well as a reduced risk for NAFLD.

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Review article: coffee consumption, the metabolic syndrome and non-alcoholic fatty liver disease.

Aliment Pharmacol Ther.  2013; 38(9):1038-44 (ISSN: 1365-2036)

Yesil A; Yilmaz Y

BACKGROUND: Coffee consumption may modulate the risk of the metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD).

AIM: To review the experimental, epidemiological and clinical studies investigating the association between coffee consumption and the risk of MetS and NAFLD.

METHODS: A literature search was conducted with the aim of finding original experimental, epidemiological and clinical articles on the association between coffee consumption, MetS and NAFLD. The following databases were used: PubMed, Embase, Scopus and Science Direct. We included articles written in English and published up to July 2013.

RESULTS: Three experimental animal studies investigated the effects of coffee in the MetS, whereas five examined whether experimental coffee intake may modulate the risk of fatty liver infiltration. All of the animal studies showed a protective effect of coffee towards the development of MetS and NAFLD. Moreover, we identified eleven epidemiological and clinical studies that met the inclusion criteria. Of them, six were carried out on the risk of the MetS and five on the risk of NAFLD. Four of the six studies reported an inverse association between coffee consumption and the risk of MetS. The two studies showing negative results were from the same study cohort consisting of young persons with a low prevalence of the MetS. All of the epidemiological and clinical studies on NAFLD reported a protective effect of coffee intake.

CONCLUSIONS: Coffee intake can reduce the risk of NAFLD. Whether this effect may be mediated by certain components of the MetS deserves further investigation.

References

Bhoo-Pathy N, Uiterwaal CS, Dik VK, et al. Intake of coffee, decaffeinated coffee, or tea does not affect risk for pancreatic cancer: results from the European Prospective Investigation into Nutrition and Cancer Study. Clin Gastroenterol Hepatol. 2013;11:1486-1492.

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The Metabolic Syndrome and Chronic Liver Disease

Curr Pharm Des. 2013 Dec 5. [Epub ahead of print]

Rosselli M, Lotersztajn S, Vizzutti F, Arena U, Pinzani M, Marra F.

Dipartimento di Medicina Sperimentale e Clinica Largo Brambilla, 3 I-50134 Florence, Italy. fabio.marra@unifi.it.

Abstract

The prevalence of the metabolic syndrome (MetS), a cluster of cardiovascular risk factors associated with obesity and insulin resistance, is dramatically increasing in Western and developing countries. This disorder is not only associated with a higher risk of appearance of type 2 diabetes and cardiovascular events, but impacts on the liver in different ways. Nonalcoholic fatty liver disease (NAFLD) is considerd the hepatic manifestation of the MetS, and is characterized by triglyceride accumulation and a variable degree of hepatic injury, inflammation, and repair. In the presence of significant hepatocellular injury and inflammation, the picture is defined 'steatohepatitis' (NASH), that has the potential to progress to advanced fibrosis and cirrhosis. Diagnosis of NASH is based on a liver biopsy, and active search for noninvasive tests is ongoing. Progression of steatohepatitis to advanced fibrosis or cirrhosis has been shown in at least one third of patients followed with paired biopsies. Presence of NASH is associated with lower life expectancy, both due to liver-related death and an increase in cardiovascular events. The appearance of NAFLD is mainly dependent on increased flow of fatty acids derived from an excess of lipolysis from insulin-resistant adipose tissue. Development of NASH is based on lipotoxicity and is influenced by signals derived from outside the liver and from intrahepatic activation of inflammatory and fibrogenic pathways. The presence of the MetS is also associated with worse outcomes in patients with cirrhosis due to any causes, and has complex interactions with hepatitis C virus infection. Moreover, the MetS poses a higher risk of development of hepatocellular carcinoma, not necessarily through the development of NASH-related cirrhosis. In conclusion, the presence of metabolic alterations has a severe and multifaceted impact on the liver, and is responsible for a higher risk of liver-dependent and -independent mortality.

PMID: 24320032 [PubMed - as supplied by publisher]

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