Pathophysiology of NASH: Have new risk factors been identified?

Nicolas Lanthier Published in the journal : September 2020 Category : Hépato-gastroentérologie

Due to the rising prevalence of obesity, non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide. NAFLD refers to a disease spectrum that encompasses steatosis and non-alcoholic steatohepatitis (NASH). NASH, which is the inflammatory subtype of NAFLD, has a clear potential of progression to fibrosis and cirrhosis, and can be associated with the need for transplantation. Identification of NAFLD and NASH is important in order to prevent disease worsening and to provide adequate tools for counteracting the causal factors. Risk factors associated with NAFLD and NASH include clinical comorbidities such as the metabolic syndrome, which is more relevant than high body mass index. Further recently identified characteristics, such as dietary composition, intestinal dysbiosis, genetic predisposition, altered brown adipose tissue, muscle alterations, circadian clock disruption or environmental chemicals, are presented in this review.

Read more

2019 innovations In hepato-gastroenterology and hepatic transplantation surgery

Géraldine Dahlqvist, Bénédicte Delire, Olivier Dewit, Laurent Coubeau, Yves Horsmans, Nicolas Lanthier, Tom Moreels Published in the journal : February 2020 Category : Hépato-gastroentérologie

Overall, 30% and 3% of the Belgian population suffer from fatty liver and its severe form, non-alcoholic steatohepatitis (NASH), respectively. To date, there is no pharmacological treatment in the NASH field. Nevertheless, encouraging results have been described with obeticholic acid in a Phase 3 study. As a consequence, obeticholic acid is considered a promising therapeutic strategy. In the area of chronic inflammatory bowel disease, tofacitinib (Xeljanz®) is reimbursed since September 2019 in case of first-line treatment failure in ulcerative colitis patients, providing new perspectives to patients affected by this disease. Poorly known 10 years ago, the hepatitis E virus has recently gained interest. In Europe and more particularly in Belgium, genotype 3 is responsible for the majority of cases. Hepatitis E virus infection should be checked for in each acute hepatitis case. The disease can be more severe in two sub-populations, namely patients suffering from chronic liver disease that can decompensate in this context and immunocompromised patients in whom the infection can become chronic. Great advances in the field of enteroscopy were also confirmed in 2019, due to the techniques enabling the biliopancreatic system to be accessed in patients with an altered anatomy of the upper digestive tract (gastric bypass,etc.) or through the use of motorized spiral enteroscopy. All of these techniques are employed at the Cliniques universitaires Saint-Luc. Finally, the last part of this review will be devoted to liver transplantation and the UCL-ALDAPT clinical study, whose objective is to assess the validity of a 2-stage total hepatectomy surgical procedure associated with a left-liver transplantation, so as to minimize risks in adult-to-adult living donor liver transplantation.

Read more

Cirrhosis management in general medical practice

Sophie Paternostre (1), Jean-Cyr Yombi (1), Peter Stärkel (2) Published in the journal : January 2019 Category : Hépato-gastroentérologie

Liver cirrhosis is commonly encountered in general practice. Although cirrhosis can result from various causes, it most often has a toxic (alcohol), metabolic (nonalcoholic steatohepatitis [NASH]), or infectious (hepatitis B and C) origin. The initial evaluation includes a blood test and an abdominal ultrasound. The diagnosis can be confirmed with non-invasive quantification of fibrosis, using either biological markers (FibroTest®) or transient elastography (FibroScan®). A liver biopsy is only rarely required. Therapeutic management of cirrhosis involves the treatment of the underlying disease, along with the management of complications. Complete alcohol abstinence, weight loss, and the control of risk factors, such as the metabolic syndrome, are some examples. In case of confirmed cirrhosis, abdominal ultrasound and alpha-fetoprotein measurements should be performed every 6 months to screen for hepatocarcinoma. It is also recommended to conduct a gastroscopy every 2-3 years to assess the presence of esophageal varices.

Read more

Hepatic insufficiency under antidepressant therapy with phenelzine

Véronique Delugeau, Julian Muguerza, Alain Cohen, Serge Goffinet Published in the journal : January 2017 Category : Hépato-gastroentérologie

Depression is a major public health concern, with an increasing proportion of the population under antidepressants. Depending on depression severity, different drug regimens are proposed. Among them, monoamine oxidase inhibitors are indicated in the event of resistance to other treatments. We report a case of drug-induced subfulminant hepatitis occurring 2 months after the first use of phenelzine.

Key Words

IMAO, antidepressant, acute hepatic insufficiency

Read more