Journal of Clinical and Experimental Hepatology最新文献

{"title":"Burden of Minimal Hepatic Encephalopathy in Literate Cirrhotics Aged 15–50 Years: Time to Switch to Digital Diagnostic Tools?","authors":"Saubhik Ghosh ,&nbsp;Tryambak Samanta ,&nbsp;Subhadip Rakshit ,&nbsp;Kalidas Biswas ,&nbsp;Pushpak Das ,&nbsp;Manoj K. Gupta ,&nbsp;Sanjay K. Mandal","doi":"10.1016/j.jceh.2026.103472","DOIUrl":"10.1016/j.jceh.2026.103472","url":null,"abstract":"<div><h3>Background</h3><div>Minimal hepatic encephalopathy (MHE) is a frequent but underdiagnosed entity associated with impaired quality of life and progression to overt hepatic encephalopathy. The Psychometric Hepatic Encephalopathy Score (PHES) remains the conventional diagnostic modality, but digital tools such as Stroop test (EncephalApp) and Critical Flicker Frequency (CFF) offer promising alternatives.</div></div><div><h3>Methods</h3><div>In this cross-sectional study (July 2022–June 2025), 316 cirrhotics with formal education ≥10 years in the age group of 15–50 years underwent PHES, Stroop, and CFF testing. MHE was diagnosed using a PHES score of ≤−5.</div></div><div><h3>Results</h3><div>Ninety-five patients (30.06%) were diagnosed with MHE. On multivariate logistic regression analysis, Model for End Stage Liver Disease-Sodium (MELD-Na) and presence of Low Hand-grip Strength (probable sarcopenia) were found to be significant predictors of presence of MHE. The internally validated cutoff 212 s of OffTime+OnTime had the best discriminative ability (AUC 0.95) among the measures of Stroop test. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Stroop and CFF as diagnostic tools were 92.63%, 91.85%, 83.02%, 96.67% and 78.95%, 88.69%, 75.00%, 90.74% respectively. The correlation(ρ) of PHES with Stroop test timings, PHES with CFF Hz, and Stroop test timings with CFF Hz was −0.93, 0.92, and −0.86, respectively, with substantial agreement between the 3 diagnostic tools [Fleiss’ Kappa(κ) 0.69]. The time to complete the session in minutes for patients was the shortest with the Stroop test [Median(IQR): 9.90 (8.50–10.33)] and patient acceptance rated on a 10-point scale was highest for CFF tool [Median(IQR): 8.47 (8.21–8.63)].</div></div><div><h3>Conclusion</h3><div>Stroop and CFF diagnostic modalities are reasonably accurate and better accepted alternatives to PHES in younger literate cirrhotics. Their integration into clinical practice may enable wider screening and timely management of MHE.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 3","pages":"Article 103472"},"PeriodicalIF":3.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Usability and Acceptability of Blood-based Hepatitis C Virus Self-testing Among Residents of Urban Slums in Northern India: A Cross-sectional Study","authors":"Ajeet S. Bhadoria ,&nbsp;Amrita Mehndiratta ,&nbsp;Kathirvel Soundappan ,&nbsp;Rajesh Somvanshi ,&nbsp;Muhammad S. Jamil ,&nbsp;Niklas Luhmann","doi":"10.1016/j.jceh.2025.103432","DOIUrl":"10.1016/j.jceh.2025.103432","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Globally, only 36% of people with hepatitis C are aware of their infection, and just 20% of those diagnosed receive treatment, highlighting a significant diagnosis and treatment gap. The World Health Organization recommends hepatitis C virus self-testing (HCVST) as an additional strategy to increase access to diagnosis.</div></div><div><h3>Methods</h3><div>From July 2023 to April 2024, we conducted a cross-sectional study nested within a larger cluster randomized control trial (RCT) (CTRI/2023/07/054590) in urban slums of Haridwar. A total of 465 participants were recruited from community and urban primary health center settings. Under observation, participants performed hepatitis C virus (HCV) self-testing, allowing assessment of usability by tracking errors using standardized checklists, user-reported difficulties, and inter-reader concordance (self vs. trained personnel interpretation). For acceptability, a pre-tested questionnaire collected socio-demographic data, risk factors for HCV, participant experiences, and responses to hypothetical test results. Additionally, 35 ELISA-positive individuals were recruited to assess the sensitivity and specificity of the self-testing kit.</div></div><div><h3>Results</h3><div>Participants, mostly aged 26–35 years with primary education, demonstrated high usability, over 90% correctly performed critical steps like finger pricking, and 96% interpreted results accurately. Participants with education beyond high school had better interpretation accuracy (98.8% vs. 94.4%, <em>P</em> = 0.02). The process was reported as significantly easier by males (85.2% vs. 71.9%), participants under 46 years (82.4% vs. 66.1%), and those with higher education (90.1% vs. 71.6%, <em>P</em> &lt; 0.001). Satisfaction was high (94.2%), and 95.4% trusted the test's accuracy. Inter-reader concordance was 95.9% (Cohen's Kappa = 0.25; 95% confidence interval [CI]: 0.07–0.43). Sensitivity and specificity were 97.4% and 99.6%, respectively.</div></div><div><h3>Conclusion</h3><div>The HCV self-testing was highly usable and acceptable among residents of urban slums. While participants valued privacy and convenience, challenges with blood collection, instructions, and the absence of counseling were noted. HCV self-testing, if scaled up through targeted rollout and linked to counselling and treatment services, could substantially narrow the diagnostic gap and accelerate India's progress toward HCV elimination.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103432"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Adults to Children: Rethinking Albumin Therapy in Pediatric Cirrhosis","authors":"Vipul Gautam ,&nbsp;Subhash Gupta","doi":"10.1016/j.jceh.2025.103441","DOIUrl":"10.1016/j.jceh.2025.103441","url":null,"abstract":"<div><div>Albumin is a multifunctional protein with pivotal physiological roles, including maintenance of oncotic pressure, ligand binding and transport, antioxidant activity, immunomodulation, antithrombotic effects, and detoxification. Liver disease leads to quantitative as well as qualitative reduction in albumin concentrations. Oxidized albumin increases with cirrhosis severity, reducing its function and effective concentration. Recently, some studies have shown the presence of abnormal albumin isoforms in cirrhotic children. Reversibly oxidized human non-mercaptalbumin-1 (HNA1) and irreversibly oxidized human non-mercaptalbumin-2 (HNA2) have been shown to predict morbidity and mortality. Albumin dysfunction in addition to hypoalbuminemia introduces the concept of effective albumin concentration, a potential predictor of poor outcomes in pediatric cirrhosis. Long-term albumin infusion in adults with cirrhosis remains controversial as evidenced by large randomized controlled trials. As in adults, the therapeutic indications for albumin therapy in children with cirrhosis are complex and not straightforward. This review article analyses the basic albumin structure, versatile physiological functions of albumin, the implications of its abnormal forms in liver disease, and its therapeutic potential and challenges in albumin infusion therapy. The large number of ongoing studies and clinical trials for optimal use of albumin underscores its paramount position in the management of complications related to liver disorders and in improving patient outcomes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103441"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Transpapillary Gallbladder Stenting for Complicated Cholecystitis in Patients With Cirrhosis and High Surgical Risk: An Observational Study","authors":"Arka De,&nbsp;Arpit Shastri,&nbsp;Sweta Rose,&nbsp;Sahaj Rathi,&nbsp;Arwinder Singh,&nbsp;Ganesh Cp,&nbsp;Naveen Bhagat,&nbsp;Babulal Meena,&nbsp;Nipun Verma,&nbsp;Madhumita Premkumar,&nbsp;Sunil Taneja,&nbsp;Ajay Duseja","doi":"10.1016/j.jceh.2025.103462","DOIUrl":"10.1016/j.jceh.2025.103462","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cholecystitis and underlying cirrhosis represent a high-risk group for surgical intervention. In patients otherwise meriting an endoscopic retrograde cholangiopancreatography (ERCP), endoscopic transpapillary gallbladder stenting (ETGS) can serve as a bridge to cholecystectomy while awaiting liver transplant or provide long-term gallbladder (GB) drainage in those who are not surgical candidates. We evaluated the technical feasibility, clinical outcomes and safety of ETGS for complicated cholecystitis in patients with cirrhosis and high surgical risk.</div></div><div><h3>Methods</h3><div>Data of all adult cirrhotic patients with complicated cholecystitis who underwent ETGS between January 2021 and March 2025 were reviewed. Primary indication for ERCP was choledocholithiasis with or without cholangitis. Primary outcome was technical success of ETGS (successful deployment of at least one GB stent). Secondary outcomes included procedure time, safety, clinical success (symptom resolution with improvement in laboratory parameters within 72-h of stent insertion), symptom recurrence, 6-month and 12-month biliary event-free survival, and differences in outcomes among patients with one or two GB stents.</div></div><div><h3>Results</h3><div>Among 40 patients (age: 56.9 ± 14.3 years, 62.5% females, model for end-stage liver disease score: 16.4) with cirrhosis taken up for ETGS, technical success was achieved in 34 (85%) patients. Among those with technical success, clinical success was achieved in 33 (97%) patients. One and two 7-Fr double-pigtail plastic stents were deployed in 13 (38.2%) and 21 (61.8%) patients, respectively. Elective stent exchanges were not done. The median follow-up duration was 13.5 (11–18) months. One (2.9%) patient had recurrent cholecystitis at 5 months. The 6- and 12-month biliary event-free survival rates were 94% and 86.7%, respectively. No significant difference in clinical success, symptom recurrence, or 6- and 12-month survival was observed among patients with one or two stents. Mild (grade I as per the Adverse events GastRointEstinal Endoscopy classification) procedure-related adverse events occurred in two (5%) patients.</div></div><div><h3>Conclusion</h3><div>ETGS is a technically feasible and safe, therapeutic option for complicated cholecystitis in cirrhotic patients with high clinical success and favourable intermediate-term outcomes.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103462"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Interventions for the Secondary Prophylaxis of Gastric Varices Prevent Rebleeding but May Not Improve Overall Survival: A Real-world Cohort From Two Centers","authors":"Sagnik Biswas ,&nbsp;Santhosh E. Kumar ,&nbsp;Sanchita Gupta ,&nbsp;Pegatraju K. Bharadwaj ,&nbsp;Shekhar Swaroop ,&nbsp;Santhosh B. KB ,&nbsp;Anuradha Sharma ,&nbsp;Arnav Aggarwal ,&nbsp;Umang Arora ,&nbsp;Sarthak Saxena ,&nbsp;Amitkumar Chavan ,&nbsp;Rajkumar Bayye ,&nbsp;Samagra Agarwal ,&nbsp;Deepak Gunjan ,&nbsp;Rahul Kumar ,&nbsp;Shyamkumar N. Keshava ,&nbsp;Shivanand Gamanagatti ,&nbsp;Ashish Goel ,&nbsp;Shalimar","doi":"10.1016/j.jceh.2025.103416","DOIUrl":"10.1016/j.jceh.2025.103416","url":null,"abstract":"<div><h3>Background</h3><div>There is limited literature on the long-term outcomes of patients with cirrhosis following an index gastric variceal (GV) hemorrhage.</div></div><div><h3>Methods</h3><div>Patients with cirrhosis and hemorrhage from gastroesophageal varices type-2 (GOV-2) or isolated gastric varices type-1 (IGV-1) from two tertiary care centers over 8 years were retrospectively analyzed. All patients underwent endoscopic cyanoacrylate injection (ECI) for primary hemostasis. Modalities of secondary prophylaxis included endoscopic surveillance and beta-blockers (ECI and BBs), balloon-occluded retrograde transvenous obliteration (BRTO), and transjugular intrahepatic portosystemic shunt (TIPS). The incidence of rebleeding, mortality, and further decompensation among patients receiving ECI and BB was estimated and compared with a propensity score-matched (PSM) cohort of patients undergoing BRTO or TIPS.</div></div><div><h3>Results</h3><div>Three hundred and fifty-one patients were recruited. Of those 275 received ECI and BB, 54 underwent BRTO, and 22 underwent TIPS. The rebleeding rate at 1 year after ECI and BB was 19.2%, while the 1-year mortality and further decompensation rates were 19.7% and 27.8%, respectively. Rebleeding predominantly occurred from GV (76.1% of cases), with the cumulative 1-, 3-, and 5-year all-cause rebleeding rate among patients receiving ECI alone being 19.2%, 30%, and 35%, respectively. BRTO and TIPS significantly reduced all-cause rebleeding, but were associated with similar rates of further decompensation and mortality compared to ECI and BB in the PSM cohort.</div></div><div><h3>Conclusion</h3><div>BRTO and TIPS significantly reduce all-cause rebleeding as compared to ECI and BB, but their impact on further decompensation and overall survival requires further evaluation in larger cohorts.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103416"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Outgoing Editor-in-Chief: The Admirable Admiral","authors":"Pankaj Puri","doi":"10.1016/j.jceh.2026.103506","DOIUrl":"10.1016/j.jceh.2026.103506","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103506"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147537520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic Shock Management in Cirrhosis: Beyond “One-Size-Fits-All” Resuscitation With POCUS-Guided Precision","authors":"Nagasri Shankar,&nbsp;Kavish R. Patidar","doi":"10.1016/j.jceh.2026.103500","DOIUrl":"10.1016/j.jceh.2026.103500","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103500"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147538541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Both CD24+ and CD24- T Cells can Better Elucidate the Influence of CD24 on Cytokine Production","authors":"Zhencheng Zhang,&nbsp;Zaixing Yang","doi":"10.1016/j.jceh.2025.103467","DOIUrl":"10.1016/j.jceh.2025.103467","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103467"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cortex in Context: Making Sense of Hepatic Encephalopathy as a Prognostic Factor in Cirrhosis-Related Hospitalization","authors":"Adam Buckholz ,&nbsp;Elliot B. Tapper","doi":"10.1016/j.jceh.2026.103502","DOIUrl":"10.1016/j.jceh.2026.103502","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103502"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147538539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bortezomib Therapy in Autoimmune-BSEP Disease After Liver Transplantation: Case Report With Review of the Literature","authors":"Rohan Grotra ,&nbsp;Prasenjit Das ,&nbsp;Rajni Yadav ,&nbsp;Lalita Mehra ,&nbsp;Ashok Tiwari ,&nbsp;Rohan Malik","doi":"10.1016/j.jceh.2025.103418","DOIUrl":"10.1016/j.jceh.2025.103418","url":null,"abstract":"<div><div>Progressive familial intrahepatic cholestasis type 2 (PFIC-2) is a rare autosomal recessive disorder caused by mutations in the <em>ABCB11</em> gene, which encodes the bile salt export pump (BSEP). Liver transplantation is the standard treatment for end-stage liver disease in PFIC-2; however, recurrence in the form of autoimmune BSEP disease (AIBD) is a recognized posttransplant complication. AIBD is characterized by cholestasis with normal gamma-glutamyl transpeptidase, severe pruritus, and the presence of anti-BSEP antibodies. We report a case of a PFIC-2 patient who developed recurrent cholestasis and pruritus three years posttransplant. Liver biopsy revealed canalicular cholestasis and giant cell transformation, while BSEP staining on immunohistochemistry was preserved. Serological testing confirmed anti-BSEP antibody positivity. Despite aggressive therapy including plasmapheresis, intravenous immunoglobulin, and rituximab, only partial improvement was achieved, and cholestasis persisted. Given the refractory nature of the disease, bortezomib—a proteasome inhibitor targeting antibody-producing plasma cells—was administered. The patient demonstrated complete clinical and biochemical resolution following bortezomib therapy. This case highlights the diagnostic complexity of AIBD and the potential role of bortezomib in cases unresponsive to conventional immunosuppressive therapies. Early diagnosis and personalized immunomodulation remain key to improving outcomes in this rare but challenging condition.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"16 2","pages":"Article 103418"},"PeriodicalIF":3.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}