Combining the age-male-albumin-bilirubin-platelets score and shear wave elastography stratifies carcinogenic risk in hepatitis C patients after viral clearance

BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.

Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography,body mass index,and Fib-4 index

BACKGROUND Shear wave speed(SWS),shear wave dispersion(SWD),and attenuation imaging(ATI)are new diagnostic parameters for non-alcoholic fatty liver disease.To differentiate between non-alcoholic steatohepatitis(NASH)and non-alcoholic fatty liver(NAFL),we developed a clinical index we refer to as the“NASH pentagon”consisting of the 3 abovementioned parameters,body mass index(BMI),and Fib-4 index.AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.METHODS This non-invasive,prospective,observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography,SWD,and ATI were measured.Histological diagnosis based on liver biopsy was performed in 31 patients.The large pentagon group(LP group)and the small pentagon group(SP group),using an area of 100 as the cutoff,were compared;the NASH diagnosis rate was also investigated.In patients with a histologically confirmed diagnosis,receiveroperating characteristic(ROC)curve analyses were performed.RESULTS One hundred-seven patients(61 men,46 women;mean age 55.1 years;mean BMI 26.8 kg/m2)were assessed.The LP group was significantly older(mean age:60.8±15.2 years vs 46.4±13.2 years;P<0.0001).Twenty-five patients who underwent liver biopsies were diagnosed with NASH,and 6 were diagnosed with NAFL.On ROC curve analyses,the areas under the ROC curves for SWS,dispersion slope,ATI value,BMI,Fib-4 index,and the area of the NASH pentagon were 0.88000,0.82000,0.58730,0.63000,0.59333,and 0.93651,respectively;the largest was that for the area of the NASH pentagon.CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.

Progress of ulcerative colitis patients during the COVID-19 pandemic

BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.

Shear wave elastography in hepatitis C patients before and after antiviral therapy

AIM To investigate shear wave(SW) propagation velocity in patients with untreated hepatitis C and patients with sustained virological response(SVR). METHODS A total of 136 hepatitis C patients [85 patients who had not received antiviral therapy(na?ve group) and 51 patients who had received antiviral therapy and subsequently achieved SVR of at least 24 wk(SVR group)] and 58 healthy volunteers and outpatients without liver disease(control group) underwent evaluation of liver stiffness by SW elastography(SWE). Various parameters were evaluated in the chronic hepatitis C patients at the time of SWE.RESULTS SW propagation velocity(Vs) was 1.23 ± 0.14 m/s in the control group, 1.56 ± 0.32 m/s in the SVR group, and 1.69 ± 0.31 m/s in the na?ve group. Significant differences were seen between the control group and the SVR group(P = 0.0000) and between the SVR group and the na?ve group(P = 0.01417). All four fibrosis markers were higher in the na?ve group than in the SVR group. In the na?ve group, Vs was positively correlated with alanine aminotransferase(ALT)(r = 0.5372), α feto protein(AFP)(r = 0.4389), type Ⅳ collagen(r = 0.5883), procollagen Ⅲ peptide(P-Ⅲ-P)(r = 0.4140), hyaluronic acid(r = 0.4551), and Mac-2 binding protein glycosylation isomer(M2BPGi)(r = 0.6092) and negatively correlated with albumin(r =-0.4289), platelets(r =-0.5372), and prothrombinactivity(r =-0.5235). On multiple regression analysis, Vs was the most strongly correlated with ALT(standard partial regression std β = 0.4039, P = 0.00000). In the SVR group, Vs was positively correlated with AFP(r = 0.6977), type IV collagen(r = 0.5228), P-Ⅲ-P(r = 0.5812), hyaluronic acid(r = 0.5189), and M2BPGi(r = 0.6251) and negatively correlated with albumin(r =-0.4283), platelets(r =-0.4842), and prothrombin activity(r =-0.4771). On multiple regression analysis, Vs was strongly correlated with AFP(standard partial regression std β = 0.5953, P = 0.00000) and M2BPGi(standard partial regression std β = 0.2969, P = 0.03363).CONCLUSION In hepatitis C patients, liver stiffness is higher in treatment-na?ve patients than in those showing SVR. SWE may be a predictor of hepatocarcinogenesis in SVR patients.

COVID-19 pandemic and exacerbation of ulcerative colitis

BACKGROUND In 2020,the world faced the unprecedented crisis of coronavirus disease 2019(COVID-19).Besides the infection and its consequences,COVID-19 also resulted in anxiety and stress resulting from severe restrictions on economic and social activities,including for patients with ulcerative colitis(UC).Fresh acute stress exerts stronger influences than continuous stress on UC patients.We therefore hypothesized that the first wave of the COVID-19 pandemic would have serious effects on UC patients and performed this retrospective control study.AIM To determine whether the first wave of the COVID-19 pandemic would have serious effects on UC patients included in a retrospective controlled study.METHODS A total of 289 consecutive UC outpatients seen in March and April 2020 were included in this study.Modified UC disease activity index(UC-DAI)scores on the day of entry and at the previous visit were compared.An increase of≥2 was considered to indicate exacerbation.The exacerbation rate was also compared with that in 256 consecutive control patients independently included in the study from the same period of the previous year in the same manner.RESULTS No significant differences in patient characteristics or pharmacotherapies before entry were seen between the groups.Mean UC-DAI score was significantly higher in subjects during the first wave of COVID-19(0.67+0.07)compared to the previous visit(0.26+0.04;P=0.0000).The exacerbation rate was significantly increased during the first wave of COVID-19,as compared with the previous year(15.9%[46/289]vs 8.9%[23/256];P=0.0151).CONCLUSION This study demonstrated that the COVID-19 pandemic caused exacerbations in UC patients,probably through psychological and physical stress.