Alcoholic liver disease(ALD) consists of a broad spectrum of disorders, ranging from simple steatosisto alcoholic steatohepatitis and cirrhosis. Fatty liver develops in more than 90% of heavy drinkers, however only 30...Alcoholic liver disease(ALD) consists of a broad spectrum of disorders, ranging from simple steatosisto alcoholic steatohepatitis and cirrhosis. Fatty liver develops in more than 90% of heavy drinkers, however only 30%-35% of them develop more advanced forms of ALD. Therefore, even if the current "gold standard" for the assessment of the stage of alcohol-related liver injury is histology, liver biopsy is not reasonable in all patients who present with ALD. Currently, although several non-invasive fibrosis markers have been suggested as alternatives to liver biopsy in patients with ALD, none has been sufficiently validated. As described in other liver disease, the diagnostic accuracy of such tests in ALD is acceptable for the diagnosis of significant fibrosis or cirrhosis but not for lesser fibrosis stages. Existing data suggest that the use of noninvasive tests could be tailored to first tier screening of patients at risk, in order to diagnose early patients with progressive liver disease and offer targeted interventions for the prevention of decompensation. We review these tests and critically appraise the existing evidence.展开更多
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic ...The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.展开更多
Primary sclerosing cholangitis(PSC)is a premalignant condition and a welldocumented risk factor for cholangiocarcinoma(CCA)which is the most common malignancy in this setting and the leading cause of deaths in the rec...Primary sclerosing cholangitis(PSC)is a premalignant condition and a welldocumented risk factor for cholangiocarcinoma(CCA)which is the most common malignancy in this setting and the leading cause of deaths in the recent years,with an increasing incidence.PSC-associated CCA has a geographical distribution that follows the incidence of PSC,with an observed ascending gradient from the Eastern to the Western and from the Southern to the Northern countries.It may arise at any location along the biliary tree but is most common in the perihilar area.Patients with PSC and intrahepatic or perihilar CCA are typically not suitable for liver resection,which is otherwise the treatment of choice with curative intent in patients with resectable tumours,providing a radical resection with clear margins can be achieved.This largely relates to the commonly advanced stage of liver disease at presentation,which allows consideration for liver resection only for a very limited number of suitable patients with PSC.On the other hand,remarkable progress has been reached in the last decades with the implementation of a protocol combining neoadjuvant chemoradiation and orthotopic liver transplantation(OLT)for the treatment of perihilar CCA,within specific criteria.Excellent results have been achieved particularly for PSC patients with this cancer,who seem to benefit the most from this treatment,having converted this into an accepted indication for transplantation and the standard of care in several experienced centres.Intrahepatic CCA as an indication for OLT remains controversial and has not been accepted given disappointing previous results.However,as recent studies have shown favourable outcomes in early intrahepatic CCA,it may be that under defined criteria,OLT may play a more prominent role in the future.Distal CCA in the context of PSC requires aggressive surgical treatment with curative intent,when feasible.This review provides insight about particular features of CCA in the setting of PSC,with a main focus on its incidence,considerations relating to its anatomical location and implications to treatment and outcomes,through the viewpoint of historical evolution of management,and future perspectives.展开更多
Metabolic-dysfunction associated steatotic liver disease(MASLD),formerly known as non-alcoholic fatty liver disease(NAFLD)(1),is characterized by the accumulation of fat in the liver cells,independent of excessive alc...Metabolic-dysfunction associated steatotic liver disease(MASLD),formerly known as non-alcoholic fatty liver disease(NAFLD)(1),is characterized by the accumulation of fat in the liver cells,independent of excessive alcohol consumption and has emerged as the most prevalent chronic liver condition in Western countries,underscoring a significant public health concern(2).The progression of MASLD to advanced fibrosis,marked by excessive extracellular matrix deposition and scar tissue formation,is a critical stage in MASLD natural history that significantly increases the risk of liver-related complications mortality(3).Non-invasive tests(NITs),such as liver stiffness measurement(LSM)with transient elastography(TE)and serum biomarkers,have gained prominence for assessing liver fibrosis in patients with suspected/confirmed NAFLD,offering a safer and less invasive alternative to liver biopsy(4).展开更多
Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide and is a leading cause of morbidity and mortality in patients with cirrhosis (1). Although it is the second most common indication for liver ...Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide and is a leading cause of morbidity and mortality in patients with cirrhosis (1). Although it is the second most common indication for liver transplantation in Europe (2), the optimal management of patients awaiting liver transplantation is still not established (3).展开更多
文摘Alcoholic liver disease(ALD) consists of a broad spectrum of disorders, ranging from simple steatosisto alcoholic steatohepatitis and cirrhosis. Fatty liver develops in more than 90% of heavy drinkers, however only 30%-35% of them develop more advanced forms of ALD. Therefore, even if the current "gold standard" for the assessment of the stage of alcohol-related liver injury is histology, liver biopsy is not reasonable in all patients who present with ALD. Currently, although several non-invasive fibrosis markers have been suggested as alternatives to liver biopsy in patients with ALD, none has been sufficiently validated. As described in other liver disease, the diagnostic accuracy of such tests in ALD is acceptable for the diagnosis of significant fibrosis or cirrhosis but not for lesser fibrosis stages. Existing data suggest that the use of noninvasive tests could be tailored to first tier screening of patients at risk, in order to diagnose early patients with progressive liver disease and offer targeted interventions for the prevention of decompensation. We review these tests and critically appraise the existing evidence.
文摘The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.
文摘Primary sclerosing cholangitis(PSC)is a premalignant condition and a welldocumented risk factor for cholangiocarcinoma(CCA)which is the most common malignancy in this setting and the leading cause of deaths in the recent years,with an increasing incidence.PSC-associated CCA has a geographical distribution that follows the incidence of PSC,with an observed ascending gradient from the Eastern to the Western and from the Southern to the Northern countries.It may arise at any location along the biliary tree but is most common in the perihilar area.Patients with PSC and intrahepatic or perihilar CCA are typically not suitable for liver resection,which is otherwise the treatment of choice with curative intent in patients with resectable tumours,providing a radical resection with clear margins can be achieved.This largely relates to the commonly advanced stage of liver disease at presentation,which allows consideration for liver resection only for a very limited number of suitable patients with PSC.On the other hand,remarkable progress has been reached in the last decades with the implementation of a protocol combining neoadjuvant chemoradiation and orthotopic liver transplantation(OLT)for the treatment of perihilar CCA,within specific criteria.Excellent results have been achieved particularly for PSC patients with this cancer,who seem to benefit the most from this treatment,having converted this into an accepted indication for transplantation and the standard of care in several experienced centres.Intrahepatic CCA as an indication for OLT remains controversial and has not been accepted given disappointing previous results.However,as recent studies have shown favourable outcomes in early intrahepatic CCA,it may be that under defined criteria,OLT may play a more prominent role in the future.Distal CCA in the context of PSC requires aggressive surgical treatment with curative intent,when feasible.This review provides insight about particular features of CCA in the setting of PSC,with a main focus on its incidence,considerations relating to its anatomical location and implications to treatment and outcomes,through the viewpoint of historical evolution of management,and future perspectives.
文摘Metabolic-dysfunction associated steatotic liver disease(MASLD),formerly known as non-alcoholic fatty liver disease(NAFLD)(1),is characterized by the accumulation of fat in the liver cells,independent of excessive alcohol consumption and has emerged as the most prevalent chronic liver condition in Western countries,underscoring a significant public health concern(2).The progression of MASLD to advanced fibrosis,marked by excessive extracellular matrix deposition and scar tissue formation,is a critical stage in MASLD natural history that significantly increases the risk of liver-related complications mortality(3).Non-invasive tests(NITs),such as liver stiffness measurement(LSM)with transient elastography(TE)and serum biomarkers,have gained prominence for assessing liver fibrosis in patients with suspected/confirmed NAFLD,offering a safer and less invasive alternative to liver biopsy(4).
基金supported by the Canadian Association for the Study of Liver and Canadian Liver Foundation.
文摘Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide and is a leading cause of morbidity and mortality in patients with cirrhosis (1). Although it is the second most common indication for liver transplantation in Europe (2), the optimal management of patients awaiting liver transplantation is still not established (3).
