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Portal vein thrombosis （PVT） refers to thromboembolism that occurs in the extrahepatic main portal vein and/or intrahepatic portal vein branches. PVT is the result of the combined effect of multiple factors， but its pathogenesis remains unclear. Animal models are an important method for exploring the pathophysiological mechanism of PVT. Based on the different species of animals， this article reviews the existing animal models of PVT in terms of modeling methods， principles， advantages and disadvantages， and application.
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Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis-related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis-related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology and Hepatology Committee of Chinese Research Hospital Association invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis - related complications were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute gastroesophageal variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction and bacterial infections, as well as in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin - related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis-related complications.
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Gastroesophageal variceal bleeding is one of the major complications of cirrhosis and also the leading causes of death in patients with decompensated cirrhosis. Terlipressin is a triglycyl-lysine vasopressin, a synthetic vasopressin analogue that is mainly used for the treatment of acute variceal hemorrhage. This article aims to review the current status of treatment of gastroesophageal variceal bleeding with terlipressin from the perspective of evidence-based medicine.
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Peutz-Jeghers syndrome [PJS] is characterized by scattered black pigmentations on fingers and lips and multiple polyps in the gastrointestinal tract. Patients with PJS often have severe complications secondary to multiple large polyps. Herein, we present a young woman complicated with a large polyp in her colon without any clinical symptoms. We also emphasized the necessity of early diagnosis and treatment of multiple polyps in such patients
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Bacterial infection is frequently seen in patients with liver cirrhosis,and the most common type of bacterial infection is spontaneous bacterial peritonitis (SBP).In clinical practice,antibacterial agents are widely used in the treatment of SBP.In addition,antibacterial agents can reduce rebleeding and mortality rates in patients with upper gastrointestinal bleeding.However,in order to avoid bacterial resistance,the appropriate use of antibacterial agents is very important.This article reviews the indications and resistance of antibacterial agents in patients with liver cirrhosis.
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Esophageal variceal bleeding is a major complication of liver cancer and a major cause of death in patients with liver cancer.This article summarizes the current status of the treatment of liver cancer complicated by esophageal variceal bleeding, including drugs and endoscopic and interventional treatment, with an emphasis on treatment options for liver cancer complicated by esophageal variceal bleeding.
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Objective To determine the prevalence and clinical features of peripancreatic vascular abnormalities in patients with pancreatitis.Methods The clinical data of 102 pancreatitis patients between January 2013 to December 2014 in the General Hospital of Shenyang Military Command who underwent contrast enhanced CT or contrast enhanced MRI scans were retrospectively analyzed.The radiological features of peripancreatic vascular abnormalities in such patients were examined, and the clinical features of pancreatitis patients with or without peripancreatic vascular abnormalities were investigated.Results Peripancreatic vascular abnormalities were found in 18 patients(17.6%), and vascular abnormalities were relatively common in portal vessels.No significant differences were observed on the age at onset, gender ratio, smoking status, alcohol consumption and length of stay between patients with and without peripancreatic vascular abnormalities.Compared with those without peripancreatic vascular abnormalities, patients with peripancreatic vascular abnormalities had a significantly higher incidence of peripancreatic fluid collection, pancreatic pseudocyst and gastric varices, and the differences were statistically significant(all P<0.05).Conclusions Peripancreatic vascular abnormalities can be complicated with pancreatitis.Enhanced CT or enhanced MRI were valuable in the diagnosis.Pancreatic pseudocyst, peripancreatic fluid collection and gastric varices were more common in pancreatitis complicated with peripancreatic vascular abnormalities.
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Esophageal variceal bleeding is one of the most serious complications of liver cirrhosis. Upper gastrointestinal endoscopy (UGE) is the gold standard for the diagnosis of esophageal varices, but it is invasive. Recently, several studies have reported some alternative methods for the diagnosis of esophageal varices, including serological model, ultrasound parameters, liver and spleen stiffness measurement, esophageal capsule endoscopy, nuclear magnetic resonance, and computed tomography. This article reviews the accuracy of these methods in the diagnosis of esophageal varices and their clinical significance. Ultrasound parameters (splenoportal index, congestion index of the portal vein, and platelet count/spleen diameter ratio), spleen stiffness measurement, computed tomography, and esophageal capsule endoscopy are accurate in the diagnosis of esophageal varices, and therefore, they can be applied in clinical practice and the application of UGE should be reduced.
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Traditionally, liver cirrhosis has a bleeding tendency due to the reduction in blood coagulation factors, hyperfibrinolysis, thrombocytopenia, and increased portal hypertension. Some studies show that the patients with live cirrhosis are in a state of hypercoagulability and tend to develop venous thromboembolism, which greatly affects the patients′ prognosis. This article reviews the epidemiological features and risk factors of venous thromboembolism, as well as the significance of prevention of venous thromboembolism in patients with liver cirrhosis, so as to guide clinical practice.
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Liver cirrhosis is a common gastrointestinal disease. Portal vein thrombosis( PVT ) can increase the mortality of patients with liver cirrhosis. Studies showed that increased D-dimer level,spleen thickness and Child-Pugh score are independent risk factors of PVT in liver cirrhosis. In addition,increased portal vein diameter,reduced portal vein blood velocity,elevated P-selectin level can predict the development of PVT after portal hypertension surgery. This article reviewed the advances in study on risk factors of PVT in liver cirrhosis.
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Erlotinib achieves antitumor activity by selective inhibition of the epidermal growth factor receptor. This paper summarizes the results of phase Ⅱ-Ⅲ clinical trials of erlotinib in the treatment of hepatocellular carcinoma (HCC). Two phase Ⅱ clinical trials demonstrated the modest antitumor activity of erlotinib alone in patients with HCC. Additionally, two phase Ⅱ clinical trials conducted in the USA showed the excellent efficacy of erlotinib combined with bevacizumab for HCC, but with an increased risk of variceal bleeding. By contrast, two phase Ⅱ clinical trials conducted in Asia showed the poor efficacy of erlotinib combined with bevacizumab for HCC. Recently, a randomized controlled phase Ⅲ trial failed to confirm any substantial improvement in overall survival time in HCC patients treated with sorafenib combined with erlotinib compared with sorafenib alone. Future studies should identify the candidates for erlotinib among patients with HCC based on the clinical and molecular prognostic biomarkers.
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ObjectiveTo systematically evaluate the efficacy of mirabilite umbilical compress in the treatment of ascites in liver cirrhosis. MethodsThe literature on the treatment of cirrhotic ascites with mirabilite umbilical compress was searched in CNKI, VIP, Wanfang Data, and PubMed databases. A meta-analysis was carried out using the random effect model. The continuous and categorical data were expressed as aas standard mean difference (SMD) and odds ratio (OR), respectively. ResultsA total of 11 randomized controlled trials were included. The mirabilite umbilical compress treatment group showed a significantly higher response rate of ascites (OR=3.19, P＜0.0001) and significantly reduced abdominal circumference (SMD=1.69, P＜0.0001) and body weight (SMD=2.77, P＜0.0001) compared with the control group. After mirabilite umbilical compress treatment, alanine transaminase level was significantly decreased (SMD=1.92, P=00009), albumin level was significantly increased (SMD=-1.78, P=0.0006), while aspartate aminotransferase and total bilirubin levels showed no significant changes (SMD=3.39, P=0.25). ConclusionMirabilite umbilical compress is effective in the treatment of ascites in liver cirrhosis, yet its efficacy in improving liver function remains uncertain.
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Budd-Chiari syndrome (BCS) is characterized by the hepatic outflow obstruction from the small hepatic vein to the superior hepatic inferior vena cava. Portal vein thrombosis (PVT) refers to the development of thrombosis in the main portal vein, with or without thrombosis in the superior mesenteric or splenic vein. A large number of studies have shown that prothrombin (factor II, F2) G20210A mutation is related to BCS and PVT. F2 and its G20210A mutation are introduced, the effect of F2 G20210A mutation on thrombosis is reviewed, and the prevalence of F2 G20210A mutation in China is analyzed. An attempt is made to focus on the association of F2 G20210A mutation with PVT and BCS. It is believed that F2 G20210A mutation to some extent increases the risk for PVT and BCS. However, the prevalence of F2 G20210A mutation is extremely low in the Chinese population. Thus, this mutation may not be regarded as the cause of PVT and BCS in China.
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Budd-Chiari syndrome (BCS)is a rare liver disease,and there are mutual influences between BCS and pregnancy.The rela-tionship between BCS and pregnancy is systematically discussed,and the points we should pay attention to in the diagnosis and treatment of this disease are pointed out as follows:First,pregnancy is a risk factor for BCS;pregnant women with the clinical manifestations of portal hy-pertension and (or)inferior vena cava hypertension should be highly suspected of having BCS.Second,pregnancy is risky in BCS patients;pregnancy is allowable in BCS patients who have a stable condition after treatment,but they should be kept under rigorous surveillance dur-ing pregnancy and after delivery to avoid thrombosis recurrence.Third,BCS may lead to infertility in women;patients with unexplained in-fertility should be evaluated by abdominal ultrasound and computed tomography to clarify the diagnosis of BCS.
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Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.
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Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension of patients with hepatocellular carcinoma.Methods Ninety-five portal hypertension patients with hepatic carcinoma were enrolled.TIPS was performed in 63 patients and the other 32 patients received support medical care.The data referred to survival time of the 95 patients after treatment was collected by follow-up visit.The informations about success rate of TIPS,hepatic encephalopathy,rebleeding and causes of death were assessed.The Kaplan-Meier method was used to compare the survival time between two groups.The association of survival time with Child-Pugh classification and model for end-stage liver disease (MELD) score was analyzed.Results The success rate of TIPS was 97.8% with reduction of mean portal vein pressure of 13.6 cmH2O(1 cmH2O=0.098 kPa).The incidence of hepatic encephalopathy was 20.6% and rebleeding was 26.3% six months after TIPS treatment.Fifty-six patients treated with TIPS died at the end of follow-up.Twelve of which were died of variceal bleeding complicated with portal hypertension.The median survival time of TIPS group (3.67 months) was significantly longer than that of control group (1 month). Moreover, the median survival time in patients with low MELD score (≤13) was significantly longer than that in those with high MELD seore (＞13, x2=4.71,P=0.03). Whereas the median survival time was decreasing from Child-Pugh A to C(x2=15.6,P=0.00). Conclusions TIPS is one of effective and safe therapeutic methods to control portal hypertension. However, liver function is an important factor for selcetion of TIPS.
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Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) in treating Budd-Chiari syndrome (BCS) and to analyze the long-term follow-up results. Methods From October 1998 to May 2008,98 BCS patients (inferior vena cava obstruction,n = 34 ; hepatic vein obstruction, n = 22; combined obstruction, n = 42) who accepted PTA treatment successfully were investigated. The changes of clinical manifestations and liver function post-operation were observed; the long term survival rate was evaluated. Results Only two patients were complicated with transhepatic puncture tract bleeding, the prognosis was good after emergency operation. Sixty patients presented with low extremities edema, which was fully subsided after PTA.Of eighty-eight ascites patients, ascites disappeared in eighty patients after operation, and in the other eight patients combined with oral diuretic treatment post-operation. The median Rotterdam prognostic score of one month post-operation and the last follow-up time point was 0. 11 and 0. 09, significantly lowered than pre-operation (1.12). The difference was statistical significance (P=0. 000). At 1, 3, 5 years postoperative, the cumulative vessel patency rates were 96%, 94% and 94% respectively, and the cumulative survival rates were 94%, 91% and 87%. Conclusions Treating BCS with PTA has a high success rate, a good safety and a long-term survival rate.