Chavdar S Pavlov

Systematic review with meta-analysis: diagnostic accuracy of transient elastography for staging of fibrosis in people with alcoholic liver disease

The progression of hepatic fibrosis into cirrhosis is a main prognostic factor for survival in people with alcoholic liver disease. The range of cut‐off values characterising the stage of hepatic fibrosis seems to be dependent on the aetiology of the liver disease.

Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis

BackgroundSmall intestinal bacterial overgrowth (SIBO) was detected in cirrhosis in many studies. The aim is to perform a systematic review and meta-analysis on the prevalence of SIBO in cirrhosis and on the relationship of SIBO with features of cirrhosis.MethodsPUBMED search (until 14 January 2018) was performed. Specific search terms were: ‘(cirrhosis) AND (SIBO OR bacterial overgrowth)’. Studies not relating to cirrhosis or SIBO, animal studies, and non-original articles were excluded. A meta-analysis of all studies was performed using a random-effects model.Results117 references were identified by the PUBMED search. 3 references were added after handsearching the reference lists of all the articles. 99 references were excluded. 21 studies (included in total 1264 cirrhotics and 306 controls) remained for qualitative analysis and quantitative synthesis. Prevalence of SIBO for cirrhosis was 40.8% (95% CI 34.8–47.1), while the prevalence of SIBO for controls was 10.7% (95% CI 5.7–19.0). OR 6.83 (95% CI 4.16–11.21; p < 0.001). Prevalence of SIBO for decompensated cirrhosis was higher than prevalence of SIBO for compensated cirrhosis (50.5% vs. 31.2%; p < 0.001). SIBO in cirrhosis was associated with ascites (p < 0.001), minimal hepatic encephalopathy (p = 0.001), bacterial translocation (p = 0.026), spontaneous bacterial peritonitis (p = 0.008), prolonged orocecal transit time (p < 0.001), and was not associated with hypocoagulation. Further studies are required to clarify the relationship of SIBO with hyperbilirubinemia, hypoalbuminemia, overt hepatic encephalopathy in past, esophageal varices and systemic inflammation.ConclusionSmall intestinal bacterial overgrowth is more often detected in cirrhosis than in healthy persons and is associated with some features of cirrhosis.

FibroTest, transient elastography method, and combined FibroTest and transient elastography method for diagnosis of severe hepatic fibrosis and cirrhosis in adults with chronic hepatitis C

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the diagnostic accuracy of FibroTest, transient elastography method, combined FibroTest and transient elastography method, no matter the sequence, using liver biopsy as reference standard, for assessment of severe hepatic fibrosis and cirrhosis in adults with chronic hepatitis C without any co-infections such as hepatitis B, HIV, and alcoholic liver disease. • To compare the accuracy of FibroTest, transient elastography method, combined FibroTest and transient elastography method, for assessment of hepatic fibrosis in adults with chronic hepatitis C. • To explore heterogeneity analysing the following study factors: ◦ different grade of inflammation according to the liver biopsy; ◦ different lengths of liver biopsy sample; ◦ different number of portal tracts included in a liver biopsy sample; ◦ different serum levels of ALT activity. • different grade of inflammation according to the liver biopsy; • different lengths of liver biopsy sample; 1 FibroTest, transient elastography method, and combined FibroTest and transient elastography method for diagnosis of severe hepatic fibrosis and cirrhosis in adults with chronic hepatitis C (Protocol) Copyright

Editorial: in vino veritas – transient elastography for staging liver fibrosis in alcoholic liver disease – authors' reply

1. WHO. Global status report on alcohol and health. Available at: who.int/substance_abuse/publications/global_alcohol_report/en/, 2014. Last accessed January 2016. 2. Ratib S, Fleming KM, Crooks CJ, Walker AJ, West J. Causes of death in people with liver cirrhosis in England compared with the general population: a population-based cohort study. Am J Gastroenterol 2015; 110: 1149–58. 3. EASL. Clinical practice guidelines on the management of alcoholic liver disease. J Hepatol 2012; 57: 399–420. 4. Pavlov CS, Casazza G, Nikolova D, Tsochatzis E, Gluud C. Systematic review with meta-analysis: diagnostic accuracy of transient elastography for staging of fibrosis in people with alcoholic liver disease. Aliment Pharmacol Ther 2016; 43: 575–85. 5. Pavlov CS, Casazza G, Nikolova D, et al. Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people with alcoholic liver disease. Cochrane Database Syst Rev 2015; 1: CD010542. 6. Thiele M, Detlefsen S, Møller L, et al. Transient and 2dimensional shear-wave elastography provide comparable assessment of alcoholic liver fibrosis and cirrhosis. Gastroenterology 2016; 150: 123–33. 7. Mueller S, Englert S, Seitz HK, et al. Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease. Liver Int 2015; 35: 2514–21. 8. Nahon P, Kettaneh A, Tengher-Barna I, et al. Assessment of liver fibrosis using transient elastography in patients with alcoholic liver disease. J Hepatol 2008; 49: 1062–8. 9. Nguyen-Khac E, Chatelain D, Tramier B, et al. Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests. Aliment Pharmacol Ther 2008; 28: 1188–98. 10. Janssens F, de Suray N, Piessevaux H, Horsmans Y, de Timary P, Starkel P. Can transient elastography replace liver histology for determination of advanced fibrosis in alcoholic patients: a real-life study. J Clin Gastroenterol 2010; 44: 575–82. 11. Fernandez M, Trepo E, Gustot T, Degre D, Adler M, Moreno C. Fibroscan (transient elastography) is the most reliable noninvasive method for the assessment of severe fibrosis and cirrhosis in alcoholic liver disease. Hepatology 2012; 56(S1): 821A. 12. Williams R, Horton R. Liver disease in the UK: a Lancet Commission. Lancet 2013; 382: 1537–8.

Ultrasonography for diagnosis of cirrhosis in people with alcoholic liver disease

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To determine the diagnostic accuracy of ultrasonography for detecting the presence or absence of cirrhosis in people with alcoholic liver disease compared with liver biopsy as reference standard. To determine the diagnostic accuracy of any of the ultrasonography tests, B-mode or Echo-colour Doppler ultrasonography, used singly or combined, or plus ultrasonography signs, or a combination of these, for detecting hepatic cirrhosis in people with alcoholic liver disease compared with liver biopsy as a reference standard, irrespective of sequence. If results differ, we will attempt to explore heterogeneity analysing: • liver biopsy as the reference standard: ◦ different grade of inflammation (amount of ongoing inflammation and necrosis) according to the liver biopsy (below two grades compared to two or greater grades of activity); ◦ different lengths of liver biopsy sample (shorter than 15 mm compared to 15 mm or longer) or number of portal tracts (fewer than six compared to six or more), as reported in the studies; ◦ percutaneous liver biopsy versus transvenous (transjugular) liver biopsy versus laparoscopic liver biopsy; • different technical characteristics of the ultrasonography equipment (e.g., different transducers, different wave lengths); • different skills of the operator as stated by the authors; • complete abstinent (teetotallers) or non-abstinent study participants (as defined in the included studies). 1 Ultrasonography for diagnosis of cirrhosis in people with alcoholic liver disease (Protocol) Copyright