No abstract available.
Adult ; *Fatty Liver/diagnosis/etiology/pathology ; Humans ; Male

Acquiring a sustained virological response (SVR) in patients with cirrhosis or advanced hepatic fibrosis reduces liver disease-related mortality and the incidence of hepatocellular carcinoma. However, the SVR rate of the current standard of care, which is combination therapy with peg-interferon-alpha and ribavirin, is significantly lower, and treatment-related complications occur more frequently in patients with cirrhosis. Thus, antiviral treatment should be individualized in this population. This review highlights the issues associated with anti-hepatitis C virus treatment in patients with compensated and decompensated cirrhosis.
Carcinoma, Hepatocellular ; Fibrosis ; Hepatitis C* ; Humans ; Incidence ; Liver ; Liver Cirrhosis* ; Mortality ; Ribavirin ; Standard of Care

HCV-related decompensated liver cirrhosis is a life-threatening illness with an average 5-year survival rate of 50%. Because these patients have higher risk of morbidity and mortality including development of hepatocellular carcinoma, the benefits of eradicating the virus may be greater than in those with less-advanced disease. Recently, direct-acting antiviral agents (DAAs) are replacing interferon-based regimens that have serious adverse events and low tolerability in the treatment of HCV infection. Many clinical trials using combination of several DAAs with or without ribavirin are now actively on-going in HCV-related decompensated cirrhosis, and encouraging data are beginning to appear. In this review, recent advances in the treatment of HCV-related decompensated cirrhosis are introduced with special focus on new DAAs.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Hepatitis C/complications/*drug therapy/pathology ; Humans ; Interferon-alpha/therapeutic use ; Liver Cirrhosis/*complications/pathology ; Practice Guidelines as Topic ; Republic of Korea ; Ribavirin/therapeutic use

Hepatitis B virus (HBV) infection during pregnancy brings up unique management challenges. Varying aspects of care must be considered, including the effects of pregnancy on the course of HBV infection, effects of HBV infection on maternal and fetal health, treatment of HBV during and after pregnancy, and prevention of perinatal infection. For those with chronic HBV infection, the course of disease is usually unchanged during pregnancy. However, flares have been reported shortly after delivery. Women with high HBV DNA titer have an increased likelihood of perinatal transmission and may contribute to the failure of current passive-active immunoprophylaxis at birth. The aim of the present review is to provide a tool that may help physicians to manage correctly HBV infection in pregnancy.
Breast Feeding ; Cesarean Section ; DNA ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Parturition ; Pregnancy

Although the classical gold standard for diagnosing and staging non-alcoholic fatty liver disease (NAFLD) and assessing fibrosis is liver biopsy, the procedure has several drawbacks, such as sample error, subjectivity in interpretation, high cost, and a small but real risk of complications.In an attempt to replace liver biopsy and to subcategorize patients with NAFLD into different prognoses, many non-invasive methods using various biomarkers, scoring systems, and imaging methods, such as elastography, have been attempted in the last decade. This article summarizes non-invasive diagnostic tests for the diagnosis of NAFLD/Nonalcoholic steatohepatitis, as well as the limitations and merits of liver biopsy.
Biomarkers ; Biopsy ; Diagnosis* ; Diagnostic Tests, Routine ; Elasticity Imaging Techniques ; Fatty Liver* ; Fibrosis ; Humans ; Liver ; Prognosis

BACKGROUND/AIMS: The notion that acute hepatitis A superimposed on chronic hepatitis B infection leads to a worse outcome than acute hepatitis A alone remains controversial. The aim of this study was to determine the influence of the presence of hepatitis B surface antigen (HBsAg) on the severity of acute hepatitis A. METHODS: We retrospectively analyzed 449 patients hospitalized for acute hepatitis A from January 2000 to February 2010 and compared clinical outcomes based on the presence of HBsAg. RESULTS: Of the 449 patients, 30 patients were in the HBsAg-positive group and 419 in the HBsAg-negative group. The HBsAg-positive group was older than the HBsAg-negative group (36.1+/-8.3 vs 31.8+/-8.5 years, p=0.004); however, other baseline characteristics were similar between the 2 groups. Mean peak values of prothrombin time, serum total bilirubin, and serum creatinine at admission were significantly higher in the HBsAg-positive group. When comparing clinical outcomes between the 2 groups, gastrointestinal bleeding, acute renal failure, and acute liver failure were more frequently observed in the HBsAg-positive group. In particular, the incidence of acute liver failure was approximately 9-fold higher in the HBsAg-positive group than in the HBsAg-negative group (23.3% vs 3.3%; odds ratio [OR], 8.80; p<0.001). Multivariate analysis showed that HBsAg (OR, 7.43; 95% confidence interval [CI], 2.56 to 21.57) and age (OR, 1.07; 95% CI, 1.02 to 1.13) were independent risk factors for the occurrence of acute liver failure. CONCLUSIONS: In patients with chronic hepatitis B infection, acute hepatitis A is associated with more severe clinical outcomes, including acute liver failure, compared with patients with acute hepatitis A alone.
Acute Kidney Injury ; Bilirubin ; Creatinine ; Hemorrhage ; Hepatitis ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver ; Liver Failure, Acute ; Multivariate Analysis ; Odds Ratio ; Prothrombin Time ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: To investigate the efficacy and longterm outcome of esophageal variceal ligation (EVL) plus propranolol in comparison with propranolol alone for the primary prophylaxis of esophageal variceal bleeding. METHODS: A total of 504 patients were retrospectively enrolled in this study. 330 patients were in propranolol group (Gr1) and 174 patients were in EVL plus propranolol group (Gr2). The endpoints of this study were esophageal variceal bleeding and mortality. Association analyses were performed to evaluate bleeding and mortality between Gr1 and Gr2. RESULTS: EVL was more applied in patients with high risk, such as large-sized varices (F2 or F3) or positive red color signs. Total 38 patients had bleeds, 32 in Gr1 and 6 in Gr2. The cumulative probability of bleeding at 120 months was 13% in Gr1 versus 4% in Gr2 (P=0.04). The predictive factors of variceal bleeding were red color signs (OR 2.962, P=0.007) and the method of propranolol plus EVL (OR 0.160, P=0.000). 20 patients died in Gr1 and 12 in Gr2. Mortality rates are similar in the two groups compared, 6.7% in Gr1 and 6.9% in Gr2. The cumulative probability of mortality at 120 months was not significantly different in the two groups (7% in Gr1, 12% in Gr2, P=0.798). The prognostic factors for mortality were age over 50 (OR 5.496, P=0.002), Child-Pugh class B (OR 3.979, P=0.001), and Child-Pugh class C (OR 10.861, P=0.000). CONCLUSIONS: EVL plus propranolol is more effective than propranolol alone in the prevention of the first variceal bleeding in patients with liver cirrhosis.
Adrenergic beta-Antagonists/*therapeutic use ; Adult ; Aged ; Esophageal and Gastric Varices/*pathology ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*drug therapy/mortality/surgery ; Humans ; Ligation ; Liver Cirrhosis/etiology ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Proportional Hazards Models ; Propranolol/*therapeutic use ; Retrospective Studies ; Severity of Illness Index ; Survival Rate

BACKGROUND/AIMS: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area. METHODS: We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines. RESULTS: The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm. CONCLUSIONS: The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Female ; Hepatitis B/complications/*diagnosis/epidemiology ; Hepatitis B Surface Antigens/blood ; Hepatitis C/diagnosis/epidemiology ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/etiology/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Practice Guidelines as Topic ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult ; alpha-Fetoproteins/analysis

BACKGROUND/AIMS: Pegylated interferon (peginterferon) and ribavirin is the current standard therapy for chronic hepatitis C. The aims of this study were to evaluate the efficacy of peginterferon and ribavirin and to identify predictors of a sustained virological response (SVR) to the retreatment of chronic hepatitis C in Korea. METHODS: The clinical records of 91 patients with chronic hepatitis C who were retreated with peginterferon and ribavirin were retrospectively analyzed. None of the patients had previously attained a SVR, and the patients were categorized according to their previous responses (nonresponder, relapser, or inadequate treatment) to conventional interferon/ribavirin. RESULTS: The overall SVR rate was 54.9%. Independent predictors of a SVR were genotypes 2 and 3, relapse, an adherence to peginterferon of over 80%, and an early virological response (EVR). For genotype 1 patients, an adherence to peginterferon of over 80% was an independent predictor of a SVR. CONCLUSIONS: Peginterferon and ribavirin therapy is effective for the retreatment of Korean chronic hepatitis C patients who have failed interferon/ribavirin, especially in patients with genotypes 2 and 3, relapse, an adherence to peginterferon over 80%, and an EVR. For genotype 1 patients, retreatment was effective in patients with an adherence to peginterferon over 80%.
Genotype ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Recurrence ; Retreatment ; Retrospective Studies ; Ribavirin

BACKGROUND/AIMS: Visceral larva migrans, caused by Toxocara canis and Toxocara cati, has emerged as a significant cause of eosinophilic liver abscess (ELA). Differentiation of ELA associated with toxocariasis (ELA-T) from metastasis or primary liver malignancy is sometimes difficult. However, the role of albendazole treatment remains uncertain in this condition. The aim of this study was to evaluate whether albendazole can enhance the radiologic resolution of ELA-T. METHODS: We retrospectively reviewed the medical records of the patients diagnosed with ELA-T at our institution between January 2008 and December 2011. ELA-T was diagnosed based on the imaging findings on computed tomography or magnetic resonance imaging and the presence of positive serum IgG antibody for Toxocara canis. Among a total of 163 patients, 32 patients received albendazole (albendazole group) and 131 did not (control group). Baseline characteristics and fate of liver nodules were compared between the two groups. RESULTS: Baseline characteristics (age, sex, number and maximal size of lesions, eosinophil count) were similar between the two groups. Median duration for achieving radiologic resolution in the albendazole group was significantly shorter than in the control group (207 days [range 186-228] vs. 302 days [range 224-380], p=0.023). In Cox regression analysis of the cumulative rates of radiologic resolution, the hazard ratio for albendazole treatment was 1.99 (95% confidence interval, 1.22-3.23). CONCLUSIONS: Radiologic resolution of ELA-T can be accelerated with albendazole treatment. Hence, inconvenience associated with long-term follow-up and unnecessary worries among patients can be eliminated with albendazole treatment.
Adult ; Aged ; Aged, 80 and over ; Albendazole/*therapeutic use ; Animals ; Antiprotozoal Agents/*therapeutic use ; Eosinophils/*immunology ; Female ; Humans ; Immunoglobulin G/blood ; Larva Migrans, Visceral/*drug therapy/parasitology ; Liver/enzymology/metabolism ; Liver Abscess/*etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Tomography, X-Ray Computed ; Toxocara canis/immunology/isolation & purification