S. Mouri

Validation of AshTest as a Non-Invasive Alternative to Transjugular Liver Biopsy in Patients with Suspected Severe Acute Alcoholic Hepatitis

Background/Aims According to guidelines, the histological diagnosis of severe alcoholic steatohepatitis (ASH) can require liver biopsy if a specific treatment is needed. The blood test AshTest (BioPredictive, Paris, France) has been initially validated for the non-invasive diagnosis of ASH in a large population of heavy drinkers. The aim was to validate the AshTest accuracy in the specific context of use of patients with suspected severe ASH, in order to reduce the need for transjugular biopsy before deciding treatment. Methods The reference was liver biopsy, performed using the transjugular route, classified according to its histological severity as none, minimal, moderate or severe. Biopsies were assessed by the same experienced pathologist, blinded to simultaneous AshTest results. Results A total of 123 patients with severe clinical ASH (recent jaundice and Maddrey function greater or equal to 32) were included, all had cirrhosis and 80% had EASL histological definition of ASH. 95% of patients received prednisolone; and the 2-year mortality was 63%. The high AshTest performance was confirmed both for the binary outcome [AUROC = 0.803 (95%CI 0.684–0.881)] significantly higher than the AST/ALT AUROC [0.603 (0.462–0.714); P<0.001], and for the severity of ASH-score system by the Obuchowski measures for [mean (SE) 0.902 (0.017) vs. AST/ALT 0.833 (0.023); P = 0.01], as well as for the diagnosis and severity of ballooning, PMN and Mallory bodies. According to attributability of discordances, AshTest had a 2–7% risk of 2 grades misclassification. Conclusion These results confirmed the diagnostic performance of AshTest in cirrhotic patients with severe clinical ASH, in the specific context of use of corticosteroid treatment. AshTest is an appropriate non-invasive alternative to transjugular liver biopsy.

Suivre un patient cirrhotique en 2016 : Quelles complications chercher ? Comment les dépister et quels sont les grands principes de prise en charge ?

La cirrhose est un veritable probleme de sante publique puisque son incidence augmente chaque annee en France et dans le monde. Les trois causes principales sont la consommation excessive d’alcool, les infections virales, dont la prevalence va tendre a diminuer du fait des progres therapeutiques, et la NASH (Non Alcoholic Steato Hepatitis), responsable d’une augmentation exponentielle du nombre de cirrhoses. Le carcinome hepatocellulaire est une complication frequente de la cirrhose dont l’incidence est croissante et une preoccupation majeure. Du fait de l’amelioration de la prise en charge des hemorragies digestives sur cirrhose, les patients cirrhotiques atteignent des stades de plus en plus avances de leur maladie hepatique, faisant augmenter le risque d’apparition de certaines complications telles que l’ascite refractaire ou l’encephalopathie hepatique. Le suivi d’un patient cirrhotique doit etre au minimum semestriel et doit s’attacher a la fois a evaluer la gravite de l’atteinte hepatique mais aussi a depister les complications telles que le carcinome hepatocellulaire, l’ascite et les complications endoscopiques de l’hypertension portale comme les varices œsophagiennes. Les moyens disponibles combinent a la fois l’examen clinique, des examens biologiques, endoscopiques et radiologiques selon des recommandations codifiees par les societes savantes. La prise en charge d’un patient cirrhotique doit ainsi etre globale en s’attachant a chercher, en plus des complications hepatiques directes, les atteintes extrahepatiques liees a la cirrhose mais aussi liees au terrain. Le depistage precoce permet d’instaurer rapidement un traitement, de faire discuter l’indication d’une transplantation hepatique et donc a terme d’ameliorer le pronostic et la qualite de vie de ces patients.

Sodium benzoate and rifaximin are able to restore blood-brain barrier integrity in he cirrhotic rats

Hepatic encephalopathy (HE) is a severe complication of cirrhosis which independently influences prognosis. We previously showed an increase in blood-brain barrier (BBB) permeability in cirrhotic rats with HE.