Effects of proton pump inhibitor on gastroesophageal varices in patients with cirrhosis:A randomized controlled trial from China

Aims:Proton pump inhibitors(PPI)are widely used for gastroesophageal varices in patients with cirrhosis after endoscopic therapy,although the effect of PPI on these patients remains controversial.This study aimed to evaluate the effect of PPI on gastroesophageal varices in patients with cirrhosis after endoscopic therapy,including variceal bleeding and adverse events.Methods:Cirrhotic patients with endoscopically confirmed gastroesophageal varices were enrolled in this study between May 2017 and June 2019.Eligible patients were randomized into two groups:one group received PPI for 14 days and the other group did not receive PPI treatment(n=53 in each group).All patients were followed for 8 weeks.Results:During the follow‐up period,three patients(5.66%)in the PPI group experienced variceal bleeding on days 9,16,and 25 after endoscopic therapy,including two patients with acute bleeding and one with primary prophylaxis.In the non‐PPI group,three patients(5.66%)experienced variceal bleeding on days 7,42,and 56 after endoscopic therapy,including one patient with acute bleeding and two with secondary prophylaxis(p=0.990).The incidence of adverse events was similar between the two groups(37.74%vs.28.30%,p=0.30).Conclusions:PPI did not appear to reduce variceal bleeding and adverse events in patients with cirrhosis after endoscopic therapy.

Portopulmonary hypertension: Current developments and future perspectives

Portopulmonary hypertension(POPH)is a severe pulmonary vascular disease secondary to portal hy-pertension and a subset of Group 1 pulmonary hypertension(PH).The pathological changes of POPH are indistinguishable from other PH phenotypes,including endothelial dysfunction,pulmonary vasocon-striction,and vascular remodeling.These changes cause a progressive increase in pulmonary vascular resistance and afterload of the right ventricle,eventually leading to severe right heart failure.The prognosis of POPH is extremely poor among untreated patients.POPH is associated with a high risk of death after liver transplantation(LT),and severe POPH is considered an absolute contraindication for LT.However,pulmonary arterial hypertension(PAH)-targeted therapies are administered to patients with POPH,and aggressive drug treatment significantly optimizes pulmonary hemodynamics and reduces the risk of death.Therefore,early diagnosis,aggressive PAH-targeted therapies,and proper selection of liver transplant candidates are vital to reduce the risk of surgery and improve clinical outcomes.This article aims to review the results of previous studies and describe biological mechanisms,epidemiology,po-tential risk factors,and diagnostic approaches of POPH.Moreover,we introduce recent therapeutic in-terventions for the early diagnosis of POPH and efficient clinical management decisions.

Influence of Nonalcoholic Fatty Liver Disease on the Occurrence and Severity of Chronic Kidney Disease

Nonalcoholic fatty liver disease(NAFLD)is reported to affect 20-30%of adults and is accompanied by various metabolic comorbidities,where the economic and clinical burden of NAFLD is attributed to the progression of liver disease as well as the presence of extrahepatic diseases.Chronic kidney disease(CKD),which has a high incidence rate,high morbidity and mortality rates,and high medical costs,has been linked to NAFLD.CKD is associated with some metabolismrelated risk factors that overlap with metabolic comorbidities of NAFLD.Therefore,to investigate the potential factors that influence CKD occurrence,the association between NAFLD and CKD should be clarified.Some studies have confirmed that NAFLD influences the occurrence and severity of CKD,whereas some studies have indicated that there is no correlation.In this review,the results of a few studies have been discussed,the potential risk factors for CKD in NAFLD are explored,and the respective biological mechanisms are elaborated to help clinicians identify CKD in patients much earlier than it is diagnosed now and thus help in reducing the incidence of liver and kidney transplants.