scholarly journals Chronic Xiao-chai-hu Decoction Therapy Slows the Progression of Acute-on-chronic Liver Failure via Prokinetic Effects on Gastrointestinal Motility

2021 ◽  
Author(s):  
Feng Ye ◽  
Jian Zhang ◽  
Yi-long Wang ◽  
Shu-mei Lin ◽  
Xi Zhang ◽  
...  
Keyword(s):  
Liver Disease ◽  
Survival Rate ◽  
Gastric Emptying ◽  
Serum Level ◽  
Liver Failure ◽  
Hepatocyte Apoptosis ◽  
Chronic Liver Failure ◽  
Small Intestinal Transit ◽  
Tnf Α ◽  
Small Intestinal

Abstract BackgroundAcute-on-chronic liver failure (ACLF) has a high risk of mortality in liver diseases without effective treatment. Xiao Chai Hu decoction (XCHD) is a traditional herbal formula, widely administered for liver disease, including anti-hepatic fibrosis and anti-inflammatory. MethodsTo investigate whether XCHD prevents the progression of ACLF and the underlying mechanisms. Methods: Sprague–Dawley rats with compound factors were randomly divided into model control group with 30 rats and four treatment groups with 20 rats in each group: Polyene phosphatidylcholine (100 mg/kg; PP) group; high dose (44.5 g/kg; HXCHD), middle dose (26.5 g/kg; MXCHD), and low dose (8.5 g/kg; LXCHD). Firstly, liver disease progression after XCHD treatment was measured by detecting: 1) the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), and albumin, prothrombin time (PT); 2) the survival rate and rat-adapted model for end-stage liver disease (MELD) score; 3) the hepatic hyperplastic collagen fibers with Masson’s trichrome staining; 4) the serum level of TNF-α and endotoxin induced hepatocyte apoptosis expression; 5) the ileum slow waves, gastric emptying, and small intestinal transit after XCHD treatment. ResultsThe XCHD groups showed improved serum biochemical hepatic parameters, histological liver changes, and survival rate. In addition, the XCHD treatment decreased the serum level of TNF-α and endotoxin and reduced hepatocyte apoptosis. XCHD decreased the normal percentage ileum slow waves, prolonged gastric emptying, and increased the small intestinal transit of ACLF. ConclusionsXCHD prevented the progression of ACLF partially via the prokinetic effects on gastrointestinal motility to reduce TNF-α, endotoxin, and hepatocyte apoptosis.

scholarly journals A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Li ◽  
Xi Liang ◽  
Shan Xu ◽  
Ye Xiong ◽  
Jianrong Huang
Keyword(s):  
Survival Rate ◽  
Blood Loss ◽  
Liver Failure ◽  
Control Group ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Liver Support ◽  
Liver Support System

AbstractWe aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

scholarly journals Lower testosterone levels predict increasing severity and worse outcomes of hepatitis B virus-related acute-on-chronic liver failure in males

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yandi Huang ◽  
Dong Yan ◽  
Huafen Zhang ◽  
Bin Lou ◽  
Ren Yan ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Liver Failure ◽  
Composite Outcome ◽  
Chronic Liver Failure ◽  
Testosterone Levels ◽  
Severity Scores ◽  
B Virus ◽  
Male Patients

Abstract Background Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a serious liver disease with pathogenesis remaining unclear. This study aims to investigate the association between testosterone levels, stage (early, middle, or late, categorized according to clinical manifestation), severity scores, and clinical outcomes of HBV-ACLF. Methods This single-center observational study involved 160 male patients with HBV-ACLF, 151 chronic hepatitis B patients without liver failure (CHB) and 106 healthy controls (HC). Morning blood samples were collected and androgen levels analyzed by chemi-bioluminescent immunoassay. Time to death or liver transplantation within 90 days comprised the primary composite outcome. Results Serum levels of total testosterone (TT), free testosterone index (FTI), dehydroepiandrosterone sulfate and cortisol were significantly lower among HBV-ACLF than CHB and HC, while androstenedione was higher. Low TT, sex hormone binding globulin and FTI were associated with increased stage (of HBV-ACLF, ascites, and hepatic encephalopathy) and severity scores (Model for End-stage Liver Disease and Chinese Group on the Study of Severe Hepatitis B-ACLF scores). Low TT (< 142.39 ng/dL) was a risk factor for both the composite outcome and for death alone within 90 days. Multivariate analysis revealed TT to be an independent predictor for the composite outcome (hazard ratio 2.57, 95% CI 1.09–6.02; P = 0.030). Conclusion Low serum testosterone is common among male patients with HBV-ACLF and predictive of increased severity and worse outcome of the disease and may play an important role in the progression of HBV-ACLF.

scholarly journals Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Giovanni Marasco ◽  
Sinan Sadalla ◽  
Giulio Vara ◽  
Rita Golfieri ◽  
Davide Festi ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Liver Disease ◽  
Liver Failure ◽  
Chronic Liver Disease ◽  
Liver Diseases ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Sarcopenia is gaining attention as a negative prognostic factor in different fields of medicine, including chronic liver failure. However, the assessment of sarcopenia in patients with liver diseases is often neglected due to unawareness of reliable tools and methods and thus is limited to research studies. Cross-sectional imaging is a diffuse diagnostic tool and is commonly performed in patients with chronic liver failure. The last advancements in radiology image analysis using dedicated software allow an easy and standardized method to assess skeletal muscle volume. Several measures can be obtained from cross-sectional imaging analysis to evaluate sarcopenia in patients affected by chronic liver disease. We aimed to review the recent advances in imaging-based sarcopenia assessment, in particular in patients with chronic liver diseases. As a result, we found that the skeletal muscle index (SMI) seems to be a reliable method to assess sarcopenia in cirrhotic patients. Even if further studies are needed to validate proper cut-offs for each clinical endpoint, physicians are invited to consider the assessment of sarcopenia in the work-up of patients with chronic liver disease.

Acute Liver Failure

2019 ◽  
pp. 264-269
Author(s):  
James Y. Findlay ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Liver Disease ◽  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Underlying Liver Disease ◽  
Rapid Deterioration ◽  
Uncommon Condition ◽  
Acute Insult

Acute liver failure (ALF) is an uncommon condition in which an acute insult results in a rapid deterioration of liver function, encephalopathy, and coagulopathy in the absence of prior underlying liver disease. It is differentiated from rapid deterioration in the setting of underlying liver disease (acute on chronic liver failure) and from the gradual deterioration in liver function that can occur in chronic liver failure.

Liver failure

2020 ◽  
pp. 3089-3100
Author(s):  
Jane Macnaughtan ◽  
Rajiv Jalan
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hepatic Encephalopathy ◽  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Organ Failure ◽  
Clinical Manifestations ◽  
Chronic Liver ◽  
Chronic Liver Failure

Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury, with hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Acute-on-chronic liver failure is characterized by hepatic and/or extrahepatic organ failure in patients with cirrhosis associated with an identified or unidentified precipitating event. The commonest causes of acute liver failure are acute viral hepatitis and drugs. Acute-on-chronic liver failure is most commonly precipitated by infection, alcohol abuse, and superimposed viral infection. The main clinical manifestations are hepatic encephalopathy, coagulopathy, jaundice, renal dysfunction, and haemodynamic instability. Infection and systemic inflammation contribute to pathogenesis and critically contribute to prognosis. Specific therapy for the underlying liver disease is administered when available, but this is not possible for most causes of liver failure. Treatment is predominantly supportive, with particular emphasis on (1) correction or removal of precipitating factors; (2) if encephalopathy is present, using phosphate enemata, nonhydrolysed disaccharide laxatives, and/or rifaximin; (3) early detection and prompt treatment of complications such as hypoglycaemia, hypokalaemia, cerebral oedema, infection, and bleeding. The onset of organ failure should prompt discussion with a liver transplantation centre. The mortality of acute liver failure (without liver transplantation) is about 40%. Patients with acute liver failure who do not develop encephalopathy can be expected to recover completely. Those who recover from an episode of acute-on-chronic liver failure should be considered for liver transplantation because otherwise their subsequent mortality remains high.

Blockade of GRP receptors inhibits gastric emptying and gallbladder contraction but accelerates small intestinal transit in humans

2000 ◽  
Vol 94 (1-3) ◽  
pp. 9
Author(s):  
Pius Hildebrand ◽  
Lukas P. Degen ◽  
Annette Collet ◽  
Livio Rossi ◽  
Fuping Peng ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Intestinal Transit ◽  
Gallbladder Contraction ◽  
Small Intestinal Transit ◽  
Small Intestinal ◽  
Grp Receptors
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